Ultrasound examination (US) plays an essential role in my daily practice of a hand surgeon. It helps find answers to numerous questions concerning the morphology, quality and structure of normal soft tissues, such as tendons, ligaments, elements of the joint cavities, as well as their pathologic changes, including solid tumors, ganglions, hypertrophy of the affected structures, post-traumatic injuries and disease-related damage. The authors of Usefulness of sonography in the diagnosis of rheumatoid hand (1) emphasize the fact that sonography is far superior to the traditional “large scale” diagnostics, such as radiography, MRI or CT, in providing information concerning the slightest joint abnormalities, thus facilitating a precise scheduling for the introduction of surgical treatment (synovectomy). The role of ultrasound in the assessment of pathologic compression on the nerves in the upper extremity has been also paid due attention to. US examination has become to constitute a valuable supplement to electromyography in this respect. US supplies the surgeon with more than just information on the modeling of the nerve shape, but also on the extent of hypertrophy of the transverse carpal ligament, and the presence of abnormalities in the carpal tunnel, such as abnormal synovium in the tendon sheaths, as well as any other pathologies significant from the surgeon's point of view. The article highlights the role of sonography in planning surgical procedures of hand joints and its soft tissues. By rendering a perfect image of the damaged structures, not only does ultrasound examination enable to locate the ends of ruptured tendons or nerves, but also facilitates the assessment of their quality and movability and reveals adhesions. In other words, it identifies all elements which affect the planning of a surgical procedure (whether direct suturing is possible, or the defect needs to be filled with an inserted nerve or tendon graft), and prognosis. In comparison to the considerably more expensive and complex MR examination, ultrasound scan is in no way inferior in terms of determining the topography of structures, e.g. when detecting the point where the ganglion extends into the carpal joint, or determining the important neighboring structures, such as nerves or vessels. Currently, sonography is the sole dynamic modality applicable to soft tissues, thus facilitating a detection of subluxation of nerves or tendons. Moreover, it helps to conduct a quantative evaluation of the flows in the inflamed tissues, monitoring the activity of the process. Ultrasound is also an important test monitoring the healing progress of the surgically treated nerves, tendons or joints. Minimally invasive ultrasound-guided surgical procedures are yet another area of its application. These include aspiration of content from fluid compartments, precise drug administration within a joint, tendon sheath or the affected soft tissue (such as administration of growth factors in entesopathies), or subcutaneous injections for the small joints of the hand. Sonography also finds a direct application in surgical procedures such as a percutaneous pulley release which can be much more accurate when ultrasound-guided. Bearing in mind the low cost of the examination, its availability, safety and the possibility of safe numerous repeat examinations, I recommend ultrasound diagnostics in everyday practice of an orthopedic hand surgeon. Ultrasound in the hands of a skillful diagnostic specialist provides an abundance of relevant information on the condition of a locomotor organ of a treated patient, and it is a valuable addition to the “traditional” diagnostic methods. The article in question draws attention to all important aspects of the ultrasound examination of a rheumatoid hand, thus attesting for yet another time its merits for the diagnostics of this difficult disease.
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Feb 27, 2015
Jorge Sayum Filho + 5
Open Access
