Skeletal Radiology

, Volume 38, Issue 11, pp 1049–1054 | Cite as

Ultrasound of the hands and feet for rheumatological disorders: influence on clinical diagnostic confidence and patient management

  • Mark Matsos
  • Srinivasan HarishEmail author
  • Peter Zia
  • Yvonne Ho
  • Andrew Chow
  • George Ioannidis
  • Nader Khalidi
Scientific Article



The purpose of the study was to quantify the impact that ultrasound (US) of the hands and feet has on the rheumatologists' diagnostic confidence and on patient management.

Materials and methods

There were 62 consecutive referrals from two rheumatologists for US of the hands and/or feet for this prospective controlled observational study. Measurements of diagnostic confidence for both specific clinical findings as well as overall diagnosis using a Likert scale were made both before and after the US examination in each case. Proposed management was also recorded before US and then with the benefit of the US result. McNemar’s test was performed to determine differences in diagnostic certainty and proposed management before and after US.


The physician certainty for specific clinical findings increased significantly following US for synovitis (9.7 vs 38.7%), tenosynovitis (9.7 vs 46.8%), erosions (1.6 vs 58.1%), enthesitis (50.0 vs 83.9%) and other (53.2 vs 77.4%). The physician certainty for overall diagnosis increased significantly for seronegative arthritis (46.8 vs 61.3%), inflammatory osteoarthritis (46.8 vs 87.1%), and primary osteoarthritis (46.8 vs 73.0%). A total of 88.7% of patients had disease-modifying antirheumatic drugs as a proposed management option before US vs 48.4% after US. Before US, 4.8% of patients had non-steroidal anti-inflammatory drug as a proposed management option versus 45.2% after US.


Ultrasound of the hands and/or feet significantly influenced the rheumatologists' diagnostic confidence in specific clinical findings and management plans.


Ultrasound Rheumatology Hands Impact 


  1. 1.
    Kane D, Grassi W, Sturrock R, Balint PV. Musculoskeletal ultrasound—a state of the art review in rheumatology. II. Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford). 2004;43:829–38.CrossRefGoogle Scholar
  2. 2.
    Wakefield RJ, Green MJ, Marzo-Ortega H, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis. 2004;63:382–385.PubMedCrossRefGoogle Scholar
  3. 3.
    Szkudlarek M, Klarlund M, Narvestad E, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther. 2006; 8:R52.CrossRefGoogle Scholar
  4. 4.
    Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum. 2004;50:2103–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Wiell C, Szkudlarek M, Hasselquist M, et al. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res Ther. 2007;9:R119.PubMedCrossRefGoogle Scholar
  6. 6.
    Salaffi F, Filippucci E, Carotti M, et al. Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography—a preliminary study. Rheumatology (Oxford). 2008;47:54–8.CrossRefGoogle Scholar
  7. 7.
    McNally EG. Ultrasound of the small joints of the hands and feet: current status. Skeletal Radiol. 2008;37:99–113.PubMedCrossRefGoogle Scholar
  8. 8.
    Karim Z, Wakefield RJ, Conaghan PG, et al. The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions. Arthritis Rheum. 2001;44:2932–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Agrawal S, Bhagat SS, Dasgupta B. Improvement in diagnosis and management of musculoskeletal conditions with one-stop clinic-based ultrasonography. Mod Rheumatol. 2009;19:53–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32:2485–7.PubMedGoogle Scholar
  11. 11.
    Albrecht K, Grob K, Lange U, Müller-Ladner U, Strunk J. Reliability of different Doppler ultrasound quantification methods and devices in the assessment of therapeutic response in arthritis. Rheumatology (Oxford). 2008;47:1521–6.CrossRefGoogle Scholar
  12. 12.
    Bearcroft PW, Guy S, Bradley M, Robinson F. MRI of the ankle: effect on diagnostic confidence and patient management. AJR Am J Roentgenol. 2006;187:1327–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Hobby JL, Dixon AK, Bearcroft PW, et al. MR imaging of the wrist: effect on clinical diagnosis and patient care. Radiology. 2001;220:589–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Grassi W. Clinical evaluation versus ultrasonography: who is the winner? J Rheumatol. 2003;30:908–9.PubMedGoogle Scholar
  15. 15.
    Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol. 2008;18:125–31.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • Mark Matsos
    • 1
    • 4
  • Srinivasan Harish
    • 2
    • 3
    Email author
  • Peter Zia
    • 2
  • Yvonne Ho
    • 2
  • Andrew Chow
    • 5
  • George Ioannidis
    • 4
  • Nader Khalidi
    • 1
    • 4
  1. 1.Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Department of RadiologyMcMaster UniversityHamiltonCanada
  3. 3.Department of Diagnostic ImagingSt. Joseph’s HealthcareHamiltonCanada
  4. 4.Department of RheumatologySt. Joseph’s HealthcareHamiltonCanada
  5. 5.Department of RheumatologyCredit Valley HospitalMississaugaCanada

Personalised recommendations