The Role of Ultrasound in the Preoperative Evaluation of Flexor Tendon Injuries of the Hand

Abstract

Tendons abnormalities of the hand and the fingers are common disorders, particularly among athletes and in the elderly, and are a common cause of pain and loss of function. The quality of ultrasonographic (USG) assessment of anatomical structures in the hand has highly improved over the last decade. The development of high resolution with the highest possible frequency of modern ultrasound equipment and the superficial location of most tendons allows the spectrum of tendon abnormalities to be easily depicted with USG. The role of USG in the assessment of tendon disorders is steadily increasing due to its low cost, fast, widespread availability, and non-invasiveness together with the possibility that it offers a dynamic assessment. The primary purpose of this study was to investigate the overall accuracy of preoperative ultrasound of hand flexor tendons performed by radiologists in the emergency setting. We also sought to investigate whether or not bedside tendon ultrasonography can be used in addition to physical examination to expedite the diagnosis and discharge planning in patients with suspected tendon injuries. This study was conducted at the Radiodiagnosis section of the Emergency Department. It included 34 patients with age ranging from 16 to 55 years (mean ± SD = 32.0 ± 13) complaining from pain or loss of flexion of the hands and the fingers, referred for assessment of tendons. There were 58.8% male and 41.2% female patients. The results of the ultrasound, as well as physical examination, were then separately compared to operative findings. The age of the study group ranged from 16 to 55 years (mean ± SD = 32.0 ± 13). The male patients represented the majority of our cases. We noted that there was no predilection for the side injured. Only 4 patients with previously repaired torn flexor tendons were examined suspected of re-ruptured tendons following re-injury. In this study, the US demonstrated a sensitivity, specificity, and accuracy of 100%, 95%, and 97%, respectively. The physical examination had a sensitivity, specificity, and accuracy of 100%, 76%, and 85%, respectively. The average time to bedside ultrasound was 46.3 minutes compared with 138.6 minutes for wound irrigation and exploration or surgery consultation. USG of hands should be a fundamental part of the imaging protocol when tendons abnormalities of the hands and the fingers (tenosynovitis, trigger finger, tendon tear, and foreign body) are suspected, as it achieves the highest level of diagnostic confidence as it is powerful, easy, and inexpensive imaging tool.