Hand Injuries: Diagnosis by Tissue HarmonicUltra High-Resolution Ultrasound
Dr. Manal MS Hamed, M.D.
, and Yasser Allam, M.S.
Associate Professor of Radiodiagnosis, Ain Shams University
andOrthopedic Senior Specialist, Manshyat Al-Bakry MOH Teaching Hospital,
we hypothesize that ultrasound can accurately diagnose bone fractures andligament/tendon injuries of the dorsum of hand.
Methods and Materials:
This was a prospective study of adult patients with hand injuries.After written consent, patients were scanned with linear ultra high resolution ultrasoundwith tissue harmonic by the radiologist; subsequently standard radiographs wereperformed and read. The findings were confirmed by MRI. On ultrasound, fractured boneshad cortical interruptions and subperiosteal hematomas or displaced fragments. Injuredligament/tendon were thickened, hypoechoic or interrupted. Linear and multiple regressionanalysis were performed, p<0.05 was considered significant.
103 patients enrolled in the study 71 of which had positive findings. 26 hadfractures: 4 carpal, 5 metacarpal and 17 phalangeal. We had in all 68 ligaments/tendonsinjuries: 7 carpal interosseous ligaments, 6 thumb ulnar collateral ligaments, 8 extensorhood and 47 phalangeal collateral ligaments. Ultrasound missed 2 spiral shaft fracturesand one terminal phalangeal fracture. Cortical interruption /subperiosteal hematoma andchip displacement were significantly diagnostic ultrasound signs of fractures (p<0.005, R
= 0.93). Ultrasound correctly diagnosed all ligament injuries (p<0.001, R
= 0.97). Thesensitivity of ultrasound in detecting fractures was 88.461%, while it sensitivity in detectingligament injuries was 100%. The overall sensitivity for detection and characterizing handinjuries was 95.77% and the specificity was 100% with no false positive results.
ultrasound of the hand is an accurate procedure that showed excellentsensitivity and specificity in diagnosis of fractures, ligaments/tendons injuries in dorsalhand injury.Abstract was accepted for oral and poster presentation in the RSSA / BSSA 2008 inGalway, Ireland.
Ultrasound has been used to evaluate bony injuries in many areas of the body
,as well as, to evaluate ligaments, tendons, and soft tissue injuries
The advent of ultra-high-frequency sonographic transducers has significantly enhanced our ability to imagesuperficial structures. As a result, sonography now can be used to assess injuries of thetendons in the wrist and hand. Sonography provides a rapid, cheap, noninvasive, anddynamic method for examination of the soft-tissue structures of the wrist and hand
65%of scaphoid fractures are negative or equivocal on conventional radiographs obtainedimmediately after trauma; other diagnostic tools such as scintigraphy, computedtomography (CT) or MRI are employed for diagnosis to avoid unjustified immobilization,