Three-dimensional Doppler ultrasound findings in healthy wrist and finger tendon sheaths - can feeding vessels lead to misinterpretation in Doppler-detected tenosynovitis?

Mads Ammitzbøll-Danielsen,Esperanza Naredo,Mikkel Østergaard,Søren Torp-Pedersen,Iustina Janta,Lene Terslev

doi:10.1186/s13075-016-0968-3

Abstract

BackgroundThe aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis.MethodForty healthy participants (20 women and 20 men age 23-67 years) without prior history of arthritis, tendon diseases or present pain in their hands were included. Twenty participants had 3D Doppler US of the second and third finger and twenty of the right wrist. US was carried out using a GE Logiq E9 unit with a 3D US probe. The colour Doppler settings were to published recommendation.ResultsThe feeding vessels in or in close proximity to the tendon sheaths were found in the flexor and extensor tendons sheaths at least once in each participant. No significant difference in feeding vessels was seen between the radial and carpal level in the wrist (p = 0.06) or between the second and third flexor tendon sheath (p = 0.84).ConclusionDoppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers in healthy participants. These feeding vessels can be a source of error, not only due to their presence but also because they may be interpreted as being inside the tendon sheath due to blooming and reverberations artefacts. These vessels should be taken into consideration when diagnosing Doppler tenosynovitis.

Highlights

The aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis
Feeding vessels in relation to the flexor tendon area were less common at the carpal level than the radial level (p = 0.006), with a median presence of feeding vessels in the tendon sheaths of 3.00 (3.00, 3.00) and 2.00 (2.00, 3.00) compartments, at the radial and carpal level, respectively
In this study we demonstrated that feeding vessels in relation to the tendon sheaths are a common finding in the wrists and fingers of healthy participants

Summary

Introduction

The aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis. Even though Doppler US is used for diagnosing synovial inflammatory activity in arthritis, it is well-known that Doppler signals may be seen in healthy wrist and finger joints and in relation to entheses [5,6,7,8], and it is necessary to distinguish such signals from pathological signals when evaluating joints and entheses. Doppler signals from feeding vessels in or in close proximity to tendon sheaths may present pitfalls in evaluation, and there are very limited data available on this topic. In tenosynovitis some Doppler artefacts, such as reverberation and blooming, can interfere with proper interpretation of pathological flow in the synovial sheath

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