Hand

Abstract

The hand joint, though complex, has a variety of different identifiable pathologies that can be visualized by point-of-care ultrasound. In patients with blunt or penetrating trauma to the hand, it is important to evaluate for tendon laceration, as a complete laceration often requires a hand surgeon for further repair. Point-of-care ultrasound is able to evaluate both the extensor and flexor tendons of the hand to ensure their integrity. To that end, evaluation of these tendons can also provide diagnoses for nontraumatic pathologies such as “trigger finger” and can guide injection therapies for this pathology. While evaluating the same area, evaluation may be done for flexor tenosynovitis, joint effusions, phalangeal fractures, and tendonitis. Additionally, ultrasound can visualize a tear of the ulnar collateral ligament resulting in the condition called “gamekeepers thumb.” Ultrasound has been found to be effective in reliably diagnosing both ulnar collateral ligament tears and associated Stener lesions, depending upon operator competency [1, 2]. Additionally, ultrasound can allow for evaluation of occult tears of the ulnar collateral ligament otherwise missed on radiography via dynamic abduction stress testing of the thumb [3]. Differentiating these diagnoses can have a huge impact on the patient’s ultimate disposition and treatment plan, given the varied acuity of the possible diagnoses (Figs. 7.1, 7.2, 7.3, 7.4, 7.5, and 7.6).