**4.1 MRI protocol**

For MR imaging of the hand the patient is placed in prone position, with the arm elevated above the head, also known as the "superman position". When specifically imaging the thumb, the latter should be fully extended and at the center of the scanner and foam pads may be used for fixation of the area of interest. Small surface or dedicated hand or wrist coils are important in order to obtain high quality images. Axial images with respect to the fingers are first obtained and these are then used to plan sagittal and coronal views. When imaging the thumbs, coronal and sagittal views should be tilted 90° to sesamoids at the level of the metacarpophalangeal joint (**Figure 3**) [13]. It is always important to include adjacent fingers within the field of view of the image for comparison [14]. Three-Tesla MRIs are preferred due to the high resolution and detail provided for these small anatomical regions. Standard sequences used to evaluate for hand tendinous or ligamentous injury are: coronal PD, axial T1, coronal T1, sagittal T1, axial T2 and sagittal T2W sequences. When evaluating the wrist, the wrist should be at the center of the scanner with dedicated surface coils as well. Coronal images should be oriented between the radial and styloid ulnar processes and sagittal images prescribed 90° to coronals. The axial images should include approximately 2–3 cm proximal to the radiocarpal joint and at least 1 cm distal to the carpometacarpal joints [13].
