US findings in traumatic wrist and hand injuries

Abstract

Traumatic injuries of the wrist and hand are common. Ultrasonography (US) is a cost-effective, noninvasive, and effective imaging method for diagnosing traumatic lesions affecting the tendons, annular pulleys, ligaments, vessels, and nerves, and for detecting foreign bodies in the wrist and hand. The objective of this article was to review the main US findings of traumatic lesions in the wrist and hand.T he wrist and hand are the most important functional parts of the body in daily life activities and are prone to traumatic injuries. These injuries constitute 6.6% to 28.6% of all injuries and 28.0% of all musculoskeletal injuries (1, 2). According to Schoffl et al. (3), wrist and hand injuries account for 14.0% to 30.0% of all treated patients in emergency care. Although these injuries are not life-threatening, the accepted treatment strategy for traumatic injuries is immediate reconstruction of all injured tissue structures. Hence, early diagnosis of the injured tissue is important for clinical management.Current ultrasonography (US) systems equipped with linear-array transducers have improved the capability of US to examine superficial organs and tissues. As an easily accessible, rapid, noninvasive imaging technique that also provides dynamic examination, US is a good imaging modality for examining the musculoskeletal system (4, 5).The purpose of this article was to review the main US findings and discuss the potential value of this technique in the evaluation of traumatic injuries of the wrist and hand. US techniquesUsing proper US examination techniques based on a thorough knowledge of the relevant anatomy and artifacts is essential for accurate diagnosis. High-frequency linear-array transducers (7-15 MHz) are mandatory for the ultrasonographic evaluation of superficial structures. The wrist and hand are best examined with the patient seated in front of the examiner with the wrist and hand placed on a table. The transducer is held with the first three fingers, and the other fingers rest on the table to reduce contact pressure. The longitudinal axis is the principal axis and is essential for diagnosis, while the transverse images are used for support. A large amount of transmission jelly is required for good contact and near field resolution.

Ultrasonography in the diagnosis and management of non inflammatory conditions of the hand and wrist

“…Sometimes loss of the fibrilar aspect of the tendon is possible. In these situations, dynamic US examination might reveal no gliding of the tendon during finger movements, due to adherence to other soft tissues [5].…”

“…The recognition of a full tendon rupture is usually simple, based on history and physical examination: an acute pain, associated with a popping sound (described by the patient during injury), followed by a special position of the finger [5]. Still, in complicated cases, with more than one tendon involvement, in postsurgical evaluation of tendon repair, or in severe wounds, with more than one structure involved, imaging techniques are essential for diagnosis.…”

“…The patients usually are seated with hands placed on a table, to permit examination of both volar and dorsal aspects, in longitudinal and transversal axis. Examination of the hands and fingers usually requires a large amount of transmission gel, in order to avoid com-pression and to permit dynamic evaluation [5]. When acute trauma with skin lesions is investigated, sterile transmission gel, or sterile acoustic standoff pads can be used.…”

“…In chronic lesions, a hypoechoic area surrounding the foreign body might be seen, due to inflammation or granuloma formation. US evaluation, with accurate positioning of the foreign body and depictions of the surrounding anatomical structures, might improve the outcome, by optimizing surgical procedure and minimizing damage [5].…”

The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures

“…Probe is placed at the point where there is maximum sensitivity in the injured extremity and images are taken in two planes [16]. POCUS is easy to learn and practice [9].…”