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Perez-Lopez LM, Perez-Abad M, Suarez Merchan MA, Cabrera Ortiz DA. Reverse Ishiguro Extension Block Technique as an Alternative for Irreducible Osseous Mallet Finger. Tech Hand Up Extrem Surg 2024; 28:62-66. [PMID: 38084649 DOI: 10.1097/bth.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Subacute or late-presenting unstable osseous mallet finger might be hard to reduce and, therefore, remain subluxed when using the traditional Ishiguro technique. In such cases, we suggest it is best to prioritize correction of joint subluxation over step-by-step adherence to the traditional Ishiguro technique. Specifically, we contend that carrying out the procedure in reverse order typically results in an easier and more stable reduction of both joint and fracture.
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Affiliation(s)
- Laura M Perez-Lopez
- Department of Pediatric Orthopedic and Trauma Surgery, Hospital Sant Joan de Déu
| | - Miguel Perez-Abad
- Department of Hand Surgery, Kaplan Institute
- Department of Orthopedic and Trauma Surgery, Hospital de Mataró, Carr. de Cirera, Barcelona, Spain
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Gitto S, Albano D, Serpi F, Spadafora P, Colombo R, Messina C, Aliprandi A, Sconfienza LM. Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:54-60. [PMID: 37001562 DOI: 10.1055/a-2066-9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the role of ultrasound (US) in the evaluation of intrinsic and extrinsic ligaments of the wrist with magnetic resonance arthrography (MRA) as the reference standard. MATERIALS AND METHODS This prospective study included patients referred for MRA after wrist trauma. US examination was performed just before MRA. On the dorsal and palmar sides of the wrist, the intrinsic interosseus and midcarpal, extrinsic, and collateral ligaments were evaluated. MRA was performed on a 1.5-T unit. In the first 20 patients included, ligament thickness was independently assessed using US and MRA and thickness reproducibility was calculated. Ligament integrity was evaluated in all patients. RESULTS 38 patients (22 men, 16 women; mean age: 38 years) were included. Ligament thickness reproducibility ranged between 44% for the palmar ulnocapitate ligament and 71% for the palmar scaphotriquetral ligament. US had a sensitivity, specificity, positive and negative predictive values, and accuracy of 100% in the identification of tears of the palmar (n=8) and dorsal (n=3) bands of the scapholunate ligament and the ulnar collateral ligament (n=3). It had a sensitivity of 100%, specificity of 97%, positive predictive value of 50%, negative predictive value of 100%, and accuracy of 97% in the identification of tears of the palmar ulnolunate ligament (n=1). CONCLUSION Compared to MRA, US showed good reproducibility in the assessment of wrist ligament thickness and similar accuracy with respect to identifying tears of the scapholunate, palmar ulnolunate, and ulnar collateral ligaments.
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Affiliation(s)
- Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Domenico Albano
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pierino Spadafora
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Loomis KJ, Shin J, Roll SC. Current and future utility of ultrasound imaging in upper extremity musculoskeletal rehabilitation: A scoping review. J Hand Ther 2023:S0894-1130(23)00141-2. [PMID: 37863730 DOI: 10.1016/j.jht.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023]
Abstract
STUDY DESIGN This study was a scoping review. BACKGROUND Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment. PURPOSE OF THE STUDY This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility. METHODS Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility. RESULTS Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians. CONCLUSION Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.
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Affiliation(s)
- Katherine J Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Jiwon Shin
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
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Meyer Zu Reckendorf G, Artuso M, Kientzi M, Rouzaud JC. Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthop Traumatol Surg Res 2023; 109:102952. [PMID: 33951542 DOI: 10.1016/j.otsr.2021.102952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Collateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically. METHODS Twenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar). RESULTS Among the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions. Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger. Mean follow-up of the 15 patients reviewed was 24 months (8-56). Mean MP flexion-extension range of motion was 86°/11° (71-99/0-29). Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side. Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°. There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension. The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively -12% and +8%. CONCLUSION The postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Gero Meyer Zu Reckendorf
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Mickaël Artuso
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France.
| | - Mylène Kientzi
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Jean-Claude Rouzaud
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
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Wang T, Guo F, Qi H, Cui L, Liu L, Bao S, Teng J. The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint. BMC Med Imaging 2023; 23:117. [PMID: 37667237 PMCID: PMC10478303 DOI: 10.1186/s12880-023-01079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury. METHODS From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described. RESULTS Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)). CONCLUSIONS High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.
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Affiliation(s)
- Tiezheng Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Fei Guo
- Department of Ultrasound, Hospital of Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, China
| | - Hengtao Qi
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China.
| | - Liyuan Cui
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Lihua Liu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Shougang Bao
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Jianbo Teng
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Jingwu Road, Jinan, 250021, Shandong, China
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Zhu W, Zhou H, Hu Z, Chen H, Liu J, Li J, Feng X, Li X. The cross-sectional area ratio of a specific part of the flexor pollicis longus tendon- a stable sonographic measurement for trigger thumb: a cross-sectional trial. BMC Musculoskelet Disord 2023; 24:228. [PMID: 36973701 PMCID: PMC10041694 DOI: 10.1186/s12891-023-06316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Trigger thumb is a pathologic condition of the digital pulleys and flexor tendons. To find a cutoff value of the cross-sectional area ratio of specific parts of the flexor pollicis longus tendon to diagnosis trigger thumb in the high-frequency ultrasound examination. METHODS We evaluated 271 healthy volunteers and 57 patients with clinical diagnosis of trigger thumb. The cross-sectional area of the metacarpophalangeal joint of flexor pollicis longus tendon (C1) and the cross-sectional area of the midpoint of the first metacarpal of flexor pollicis longus tendon (C2) were analyzed. RESULTS There is no difference between gender, age and left and right hands in the ratio of C1 to C2 (C1/ C2). The mean of C1/ C2 in the healthy thumb was 0.983 ± 0.103, which was significantly smaller in comparison to the diseased thumb (P < 0.05). Based on the receiver operating characteristic curve, we chose the diagnostic cut-off value for the C1/ C2 to be 1.362 and 1.153 in order to differ a trigger thumb from children and adults. CONCLUSIONS The C1/ C2 of the healthy thumb was relatively stable, with a mean value of 0.983 ± 0.103. The cutoff value of C1/C2 to distinguish healthy thumb from diseased thumb in children and adults were 1.362 and 1.153, respectively.
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Affiliation(s)
- Wenbin Zhu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huan Zhou
- The Children's Heart Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhe Hu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyan Chen
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juan Liu
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jin Li
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoyuan Feng
- The Children's Heart Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueqin Li
- Ultrasonography department, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Sahin MS. The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits’ Proximal Interphalangeal Joints. Cureus 2022; 14:e28306. [PMID: 36158352 PMCID: PMC9498160 DOI: 10.7759/cureus.28306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Collateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits. Methods A retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. Results In digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p<0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727). Conclusion This study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.
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Abstract
ABSTRACT In this dynamic protocol, ultrasound evaluation of the wrist and hand is described using various maneuvers for relevant conditions. Scanning videos are coupled with real-time patient examination videos. The authors believe that this practical guide - prepared by the international consensus of several experts - will help musculoskeletal physicians perform a better and uniform/standard examination approach.
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Validation of the spontaneous lateral laxity sign for radial collateral ligament sprain of the metacarpophalangeal joint of the fingers: Anatomical study. HAND SURGERY & REHABILITATION 2022; 41:347-352. [DOI: 10.1016/j.hansur.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/20/2022]
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Madani A, Créteur V, Bianchi S. Atlas of Sonographic Anatomy of the Hand and Wrist. Hand Clin 2022; 38:1-17. [PMID: 34802601 DOI: 10.1016/j.hcl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Accurate knowledge of the technique of ultrasonographic (US) examination and of normal US appearance is a prerequisite for a successful US examination of the wrist and hand. In this article, we describe our standard US examination as well as the normal US findings of the hand and wrist.
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Affiliation(s)
- Afarine Madani
- Service de Radiologie, Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, Brussels 1070, Belgium
| | - Viviane Créteur
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, Brussels 1070, Belgium.
| | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, 40a route de Malagnou, Geneva 1208, Switzerland
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Christen S, Vögelin E. Sonography, My Personal Assistant at Hand Outpatient Clinic. Hand Clin 2022; 38:19-29. [PMID: 34802605 DOI: 10.1016/j.hcl.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasonography in hand surgery offers the option of imaging trauma consequences or degenerative problems in the wrist and fingers, involving bones, joints, ligaments, tendons, annular pulley, carpal and digital changes, soft masses, and foreign bodies including dynamic changes during motion. In the hands of the treating surgeon, ultrasonography allows immediately to plan conservative treatment versus surgery, to precisely infiltrate joints or tendon spaces as well as to perform miniinvasive assisted surgery.
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Affiliation(s)
- Samuel Christen
- Hand, Plastic and Reconstructive Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007 St.Gallen, Switzerland
| | - Esther Vögelin
- Hand Surgery and Surgery of Peripheral Nerves, Plastic and Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland.
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12
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Blum AG, van Holsbeeck MT, Bianchi S. Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions. Semin Musculoskelet Radiol 2021; 25:355-365. [PMID: 34450660 DOI: 10.1055/s-0041-1730414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.
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Affiliation(s)
- Alain G Blum
- Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France.,Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
| | | | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, Geneva, Switzerland.,Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva 14, Switzerland
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13
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Blum AG, van Holsbeeck MT, Bianchi S. Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb. Semin Musculoskelet Radiol 2021; 25:346-354. [PMID: 34374068 DOI: 10.1055/s-0041-1730397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.
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Affiliation(s)
- Alain G Blum
- Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France.,Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
| | | | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie Médicale, Geneva, Switzerland.,Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Carneiro BC, Araújo FF, Guimarães JB, Chemin RN, Jorge RB, Filho AGO, Nico MAC. Stener-like lesions in the hand, knee and foot: a review of anatomy, mechanism of injury and imaging evaluation. Clin Imaging 2021; 76:235-246. [PMID: 33975225 DOI: 10.1016/j.clinimag.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
A Stener lesion is a displaced tear of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb in which the adductor pollicis aponeurosis is positioned between the retracted ligament and the injury site, preventing natural healing. This lesion was first described in 1962, and since then, both radiologists and orthopedists have considered it important to treat surgically. Although this lesion was originally described in the thumb, this injury mechanism can occur in other joints of the hand, knee, and foot. The purpose of this study was to review the relevant aspects of classic Stener lesions of the thumb, as well as other Stener-like lesions, including their anatomy, mechanisms of lesion formation and imaging features. The Stener-like injury pattern often necessitates surgical repair or reconstruction; thus, it is essential that radiologists recognize and report the different patterns of injury.
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Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Flávia Ferreira Araújo
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Renan Nogueira Chemin
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Rafael Baches Jorge
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
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15
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Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Eur Radiol 2021; 31:5699-5712. [PMID: 33459856 DOI: 10.1007/s00330-020-07666-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine the performances of clinical examination, ultrasonography, and MRI for diagnosing non-displaced and displaced ulnar collateral ligament (UCL) tears. METHODS Based on a literature search of Medline, ISI Web of Science, Embase, and Scopus between January 1990 and December 2019, all published original articles which met the inclusion criteria were included. We determined the pooled sensitivities, specificities, and accuracies of clinical examination, ultrasonography, and MRI using a meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Diagnostic Test Accuracy (PRISMA-DTA) guidelines. RESULTS A total of 17 studies with 519 subjects reporting diagnostic performances of clinical examination (8), ultrasonography (12), and MRI (5) met the inclusion criteria. For ruling out UCL tears, the pooled sensitivities were similarly high for clinical examination (97% (95% confidence interval [CI], 93-99%)), ultrasonography (96% (95% CI, 94-98%)), and MRI (99% (95% CI, 92-100%)) (p = 0.3). For ruling in UCL tears, the pooled specificities were higher for MRI (100% (95% CI, 87-100%)) when compared to ultrasonography (91% (95% CI, 86-95%)) (p = 0.1) and clinical examination (85% (95% CI, 78-91%)) (p = 0.04). For the diagnosis of displaced UCL tears, MRI had a higher specificity (92% (95% CI, 73-99%)) than ultrasonography (72% (95% CI, 63-80%)) (p = 0.2). CONCLUSIONS Clinical examination, ultrasonography, and MRI have similarly high sensitivities for ruling out UCL tears in patients presenting with a thumb injury. MRI and ultrasonography have high specificities to confirm the presence of suspected UCL tears. MRI performs best for differentiating non-displaced from displaced UCL tears. KEY POINTS • Clinical examination followed by ultrasonography is the most appropriate test for ruling out ulnar collateral ligament (UCL) tears of the thumb. • MRI and ultrasonography both have high specificities to confirm the presence of a suspected UCL tear. • MRI outperforms ultrasonography for differentiating non-displaced from displaced UCL tears.
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Affiliation(s)
- Ali Rashidi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Arya Haj-Mirzaian
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Danoob Dalili
- Nuffield Orthopedic Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Benjamin Fritz
- Radiology, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jan Fritz
- Department of Radiology, Musculoskeletal Radiology, New York University Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm #313, New York, NY, 10016, USA.
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16
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Robotti G, Draghi F, Bortolotto C, Canepa MG. Ultrasound of sports injuries of the musculoskeletal system: gender differences. J Ultrasound 2020; 23:279-285. [PMID: 32130686 DOI: 10.1007/s40477-020-00438-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
In recent years, women and girls are increasing their sport participation, and female sports are becoming more challenging. While more women and girls are participating in sports, there is still a lack of information about gender-specific lesions. We will therefore evaluate gender differences in sports injuries, analyzing the five sports and sporting activities that are most widespread in the western world: running, soccer, basketball, water sports, and winter sports. The ability to make correct ultrasonographic diagnoses in sports injuries is improving as the technology is advancing. Ultrasonography demonstrates tissue structure with two-dimensional grayscale images, while blood flow can be visualized with color and power Doppler. Furthermore, ultrasonography is the preferred imaging modality for studying soft-tissue lesions dynamically. High-quality diagnostic ultrasound cannot be performed without the knowledge of the underlying clinical background, and an understanding of gender-specific injuries and mechanisms of injuries is therefore important for assessing proper diagnostic and treatment guidelines tailored to phenotypic differences in professional and amateur athletes between male and female.
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Affiliation(s)
- Guido Robotti
- Studio di ecografia medica e terapia del dolore, 6805, Mezzovico Lugano, Switzerland.,Istituto Radiologico Collegiata, 6512, Bellinzona, Switzerland.,UniLudes, 6900, Pazzallo Lugano, Switzerland
| | - Ferdinando Draghi
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Maria Grazia Canepa
- Studio di Medicina interna, manipolativa e terapia del dolore, 6805, Mezzovico Lugano, Switzerland
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17
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Bianchi S, Gitto S, Draghi F. Ultrasound Features of Trigger Finger: Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3141-3154. [PMID: 31106876 DOI: 10.1002/jum.15025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.
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Affiliation(s)
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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18
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Bianchi S, Becciolini M. Ultrasound Evaluation of Sesamoid Fractures of the Hand: Retrospective Report of 13 Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1913-1920. [PMID: 30380179 DOI: 10.1002/jum.14852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023]
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