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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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Mohammadhoseini P, Mohammadi SM, Mousavi Nia N. Short-Term and Long-Term Therapeutic Results of Deep Flexor Tendon Repair in Zone II in Patients Referred to Imam Khomeini Hospital, Ahvaz, Southern Iran. World J Plast Surg 2024; 13:82-86. [PMID: 38742036 PMCID: PMC11088727 DOI: 10.61186/wjps.13.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 09/03/2024] [Indexed: 05/16/2024] Open
Abstract
Background Hand injury as an important concern for the surgeon and the patient requires proper and timely treatment to prevent complications such as infection and adhesions, and with a proper rehabilitation program, the patient returns to maximum function as soon as possible. We aimed to investigate the short-term and long-term treatment results of deep flexor tendon repair in in zone II. Methods This retrospective study was performed on 34 patients with 45 injured fingers in the zone II referred to Ahvaz Imam Khomeini Hospital, Ahvaz, Iran during 2017-2019. The results of deep flexor tendons repair in two groups, immediate and delayed primary repair were assessed. Results The mean age of the patients was 27.76 years. There was no significant remarkable between male and female in the incidence of complications such as infection, tendon rupture and adhesions. 29.4% (n=10) had poor outcome, 8.8% (n=3) had fair outcome, 29.4% (n=10) had good outcome and 32.4% (n=11) had excellent outcomes. 26.5% had adhesion and infection rate was 11.8%. Conclusion Among surgeons, there is consensus for the primary repair of tendon injury, but there was no significant difference between the results of immediate and delayed primary repair. Although physiotherapy has been suggested as an effective factor in improving hand function, its positive effect on the range of motion of the fingers has not been proven.
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Affiliation(s)
- Payam Mohammadhoseini
- Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Mohammadi
- Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narjes Mousavi Nia
- Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hesse N, Reidler P, Schmitt R. [Sports-related injuries of the thumb and fingers]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:284-292. [PMID: 36917239 DOI: 10.1007/s00117-023-01127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Abstract
Finger and thumb injuries are common in established and trend sports. Imaging plays an important role in acute trauma care, further therapy planning, and ultimately for a rapid return to play. Sound knowledge of the complex anatomy of the fingers and thumb is indispensable for accurate diagnosis. This article presents the ligament anatomy of the metacarpophalangeal and interphalangeal joints of the finger and the thumb, the extensor and flexor tendon apparatus, and the diagnosis of typical sports injuries using x‑rays and magnetic resonance imaging. Furthermore, imaging findings of typical sports-associated injuries are illustrated.
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Affiliation(s)
- N Hesse
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland.
| | - P Reidler
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland
| | - R Schmitt
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
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Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand - An Update on MRI. ROFO-FORTSCHR RONTG 2022; 194:1307-1321. [PMID: 35705165 DOI: 10.1055/a-1826-1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The tendons of the hand run in close proximity to each other and within retinacular tunnels adjacent to articular joints, while forming intersections in characteristic locations. The enclosing tendon sheaths are often sites of systemic or infectious inflammation. METHOD This review article outlines the different entities of tendon and tendon sheath pathology and their manifestation in the hands. Diagnostic findings in tendon and tendon sheath disorders are illustrated using MRI imaging and discussed in context with the current literature. RESULTS AND CONCLUSION Overuse may cause stenosis in the fibrous outer layer of the retinacula and the A1 annular ligaments as well as tendinosis. In contrast, proliferative tenosynovitis is a disease of the synovial inner layer of the tendon sheath with tendon infiltration and tendinitis. Pyogenic tenosynovitis favors the flexor compartments. Because of the narrow spaces in the hand, a high-resolution MRI technique must be used. KEY POINTS · Diseases of the tendons and tendon sheaths may have a mechanical, degenerative, metabolic, systemic inflammatory, or infectious etiology.. · Fibrous tunnels and bony prominences in close proximity to crossing tendons predispose to mechanical tendon irritation at typical sites of the hand.. · Stenosing tenovaginitis occurs in the fibrous layer of the extensor retinaculum or the A1 annular pulleys. The most frequent manifestations are the "trigger finger" and de Quervain disease.. · Proliferative tenosynovitis affects the synovial layer of the tendon sheaths before infiltrating the tendons. The classic representative is rheumatoid arthritis.. CITATION FORMAT · Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand - An Update on MRI. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1826-1007.
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Affiliation(s)
- Rainer Schmitt
- Department of Radiology, University Hospital, LMU Munich, Muenchen, Germany.,Department of Radiology, University Hospital Wuerzburg, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Muenchen, Germany
| | - Jan-Peter Grunz
- Department of Radiology, University Hospital Wuerzburg, Germany
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Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
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HASHIMOTO A, TSUBOKAWA N, SONOHATA M, MAWATARI M. Limited Active Metacarpophalangeal Extension of the Ring Finger Due to Scarring of the Juncturae Tendinum: A Case Report. J Hand Surg Asian Pac Vol 2022; 27:565-569. [DOI: 10.1142/s2424835522720249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A limitation of finger extension resulting from scarring of the juncturae tendinum (JT) is a rare condition. We report a patient with limitation in active extension of the metacarpophalangeal joint (MCPJ) of the ring finger due to a scarred JT in a 37-year-old man. Surgical exploration showed a hard, fixed and scarred JT in the third intermetacarpal space. After resection of the scarred JT, the patient achieved full range of active extension of the ring finger MCPJ. Scarring of the JT may decrease excursion of the extensor digitorum communis and must be considered as one of the differentials in patients with limitation in MCPJ extension. Level of Evidence: Level V (Therapeutic)
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Affiliation(s)
- Akira HASHIMOTO
- Niigata Hand Surgery Foundation, Kitakanbara-gum, Niigata, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Naoto TSUBOKAWA
- Niigata Hand Surgery Foundation, Kitakanbara-gum, Niigata, Japan
| | - Motoki SONOHATA
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki MAWATARI
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Rosskopf AB, Martinoli C, Sconfienza LM, Gitto S, Taljanovic MS, Picasso R, Klauser A. Sonography of tendon pathology in the hand and wrist. J Ultrason 2021; 21:e306-e317. [PMID: 34970442 PMCID: PMC8678645 DOI: 10.15557/jou.2021.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022] Open
Abstract
Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high-quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.
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Affiliation(s)
- Andrea B Rosskopf
- Radiology, Balgrist University Hospital, University of Zurich, Switzerland.,Radiology, ARISTRA, Switzerland
| | - Carlo Martinoli
- Department of Health Science (DISSAL), Università di Genova, Italy.,IRCCS, Ospedale Policlinico San Martino, Italy
| | - Luca M Sconfienza
- IRCCS, Istituto Ortopedico Galeazzi, Italy.,Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Mihra S Taljanovic
- Department of Radiology, University of New Mexico, United States.,Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, United States
| | | | - Andrea Klauser
- Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Austria
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