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Role of Ultrasound in Flexor Tendon Injuries of the Hand: A New Insight

      Abstract

      This study was aimed at validating the diagnostic accuracy of ultrasound (US) scans in pre-operative evaluation of flexor tendon injuries in the hand and to determine its value in the management of such injuries and in the prediction of patient outcome. This descriptive cross-sectional prospective study included 35 patients with penetrating trauma to the volar aspect of the hand or wrist with questionable clinical findings. They had 50 injured tendons and were candidates for exploratory surgery versus physiotherapy. They underwent pre-operative US to guide their management. Ultrasound results were compared with the operative findings as the gold standard test. Patients were followed up postoperatively, and functional outcome was assessed and correlated with pre-operative sonographic findings. Our results indicate that sonographic examination of hand tendon injury has high accuracy in diagnosing complete or partial flexor injuries, with 100% accuracy, sensitivity and specificity in diagnosing full-thickness tears as well as tenosynovitis of hand flexor tendons. Zonal II injury was the most frequent among our study population and correlated with poorest functional outcome after rehabilitation at 3 mo follow-up. US of the hand is a fast, inexpensive and potentially indispensable dynamic tool for accurate assessment of flexor tendon injuries. It provides data on the extent of injury that effectively helps both set up an appropriate operative plan and predict the patient's functional outcome post-operatively, which in turn will have a direct impact on the patient's rehabilitation plan and lifestyle. Thus, it should be a fundamental part of the management of patients with tendon injuries.

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      References

        • Ahmad T
        • Jan S
        • Rashid S.
        Management of flexor tendon injuries in hand.
        in: Tendons. IntechOpen. 2019https://doi.org/10.5772/intechopen.83483
        • Akhavan R
        • Bolvardi E
        • Pezeshki-Rad M
        • Abbasi B.
        Diagnosing hand and wrist tendon injuries in patients with questionable physical findings: Let POCUS show its true mettle.
        Trauma Mon. 2019; 24: 1-5
        • Al-Hourani K
        • Gamble D
        • Armstrong P
        • O'Neill G
        • Kirkpatrick J.
        The predictive value of ultrasound scanning in certain hand and wrist conditions.
        J Hand Surg Asian Pac. 2018; 23: 76-81
        • AllaDawoud O
        • Lebida I
        • Khalel D
        • Gabal M.
        Role of diagnostic ultrasonography in evaluation of hand and wrist lesions.
        ZUMJ. 2016; 22: 1-10
        • Bal S
        • Oz B
        • Gurgan A
        • Memis A
        • Demirdover C
        • Sahin B
        • Oztan Y.
        Anatomic and functional improvements achieved by rehabilitation in zone II and zone V flexor tendon injuries.
        Am J Phys Med Rehabil. 2011; 90: 17-24
        • Bircan C
        • El O
        • Akalin E
        • Bacakoglu AK
        • Gulbahar S
        • Sahin E
        • Ozkan M
        • Kizil R
        Functional outcome in patients with zone V flexor tendon injuries.
        Arch Orthop Trauma Surg. 2005; 125: 405-409
        • Chan TK
        • Ho CO
        • Lee WK
        • Fung YK
        • Law YF
        • Tsang CY.
        Functional outcome of the hand following flexor tendon repair at the ‘no man's land.
        J Orthop Surg. 2006; 14: 178-183
        • Chiavaras MM
        • Jacobson JA
        • Yablon CM
        • Brigido MK
        • Girish G.
        Pitfalls in wrist and hand ultrasound.
        Am J Roentgenol. 2014; 203: 531-540
        • Dy CJ
        • Daluiski A.
        Update on zone II flexor tendon injuries.
        J Am Acad Orthop Surg. 2014; 22: 791-799
        • Ishak A
        • Rajangam A
        • Khajuria A.
        The evidence-base for the management of flexor tendon injuries of the hand.
        Ann Med Surg. 2019; 48: 1-6
        • Jacob D
        • Cohen M
        • Bianchi S.
        Ultrasound imaging of non-traumatic lesions of wrist and hand tendons.
        Eur Radiol. 2007; 17: 2237-2247
        • Jeyapalan K
        • Bisson MA
        • Dias JJ
        • Griffin Y
        • Bhatt R.
        The role of ultrasound in the management of flexor tendon injuries.
        J Hand Surg Eur. 2008; 33: 430-434
        • Kuran B.
        Functional assessment in hand with flexor and extensor tendon injuries.
        Hand function: A practical guide to assessment. Springer, Cham2019: 109-124
        • Lapegue F
        • Andre A
        • Brun C
        • Bakouche S
        • Chiavassa H
        • Sans N
        • Faruch M.
        Traumatic flexor tendon injuries.
        Diagn Interv Imaging. 2015; 96: 1279-1292
        • Lee DH
        • Robbin ML
        • Galliott R
        • Graveman VA.
        Ultrasound evaluation of flexor tendon lacerations.
        J Hand Surg Am. 2000; 25: 236-241
        • Libberecht K
        • Lafaire C
        • Van Hee R.
        Evaluation and functional assessment of flexor tendon repair in the hand.
        Acta Chir Belg. 2006; 106: 560-565
        • O'Brien M
        • Burke F.
        Flexor and extensor injuries in the hand.
        in: Bentley G European Surgical Orthopaedics and Traumatology. Springer, Berlin/Heidelberg2014: 1955-1976
        • Ravnic DJ
        • Galiano RD
        • Bodavula V
        • Friedman DW
        • Flores RL.
        Diagnosis and localisation of flexor tendon injuries by surgeon-performed ultrasound: A cadaveric study.
        J Plast Reconstr Aesthet Surg. 2011; 64: 234-239
        • Schöffl V
        • Heid A
        • Küpper T.
        Tendon injuries of the hand.
        World J Orthop. 2012; 3: 62-69
        • Sconfienza LM
        • Albano D
        • Allen G
        • Bazzocchi A
        • Bignotti B
        • Chianca V
        • de Castro FF
        • Drakonaki EE
        • Gallardo E
        • Gielen J
        • Klauser AS.
        Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus.
        Eur Radiol. 2018; 28: 5338-5351
        • Situ-LaCasse E
        • Grieger RW
        • Crabbe S
        • Waterbrook AL
        • Friedman L
        • Adhikari S.
        Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology.
        World J Emerg Med. 2018; 9: 262-266
        • Snedeker JG
        • Foolen J.
        Tendon injury and repair–A perspective on the basic mechanisms of tendon disease and future clinical therapy.
        Acta Biomater. 2017; 63: 18-36
        • Soubeyrand M
        • Biau D
        • Jomaah N
        • Pradel C
        • Dumontier C
        • Nourissat G.
        Penetrating volar injuries of the hand: Diagnostic accuracy of US in depicting soft-tissue lesions.
        Radiology. 2008; 249: 228-235
        • Wang PT
        • Bonavita JA
        • DeLone Jr, FX
        • McClellan RM
        • Witham RS.
        Ultrasonic assistance in the diagnosis of hand flexor tendon injuries.
        Ann Plast Surg. 1999; 42: 403-407
        • Wu T
        • Roque P
        • Green J
        • Drachman D
        • Khor K
        • Rosenberg M
        • Simpson C.
        Bedside ultrasound evaluation of tendon injuries.
        Am J Emerg Med. 2012; 30: 1617-1621
        • Zhang GY
        • Zhuang HY
        • Wang LX.
        Value of high frequency ultrasonography in diagnosis and surgical repair of traumatic finger tendon ruptures.
        Med Princ Pract. 2012; 21: 472-475