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Hand Arthropathies

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Manual of Musculoskeletal Ultrasound

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Abstract

Not long ago, rheumatologists faced a dilemma: The patient has a history compatible with an inflammatory disease, but the physical examination and X-rays were unhelpful. How can one determine an inflammatory condition from a noninflammatory condition? How can you distinguish seronegative rheumatoid arthritis from psoriatic arthritis, particularly in the absence of psoriasis? Certainly, an MRI might help if insurance covers it and a musculoskeletal radiologist can read it. Ultrasound will instantly detect and grade synovitis, cartilage erosion, and tenosynovitis. Enthesitis, so critical in diagnosing spondyloarthropathy, is immediately apparent. Ultrasound is more sensitive than radiographs for detecting bony erosion.

Ultrasound may detect calcium deposition not apparent on plain radiographs, thus bringing the potential diagnosis of pseudogout to the forefront. In rheumatoid arthritis, rheumatologists do not base treatment intensity upon power Doppler activity; however, ultrasound delineates subclinical synovitis and, thus, whether to treat a patient. Hand surgeons also have their plight: They depend on MRI to delineate the origin of a mass or soft tissue swelling in the hand. Ultrasound will disclose a ganglion cyst causing a trigger finger refractory to multiple injections. Likewise, ultrasound may instantly delineate ligament and tendon tears, triangular fibrocartilage tears, transection neuromas, and a glomus tumor. Ultrasound will tell the hand surgeon that the source of pain is inflammatory, and a rheumatology referral is necessary. Further, ultrasound may improve the accuracy and safety of injections of a trigger finger, a small joint, or the first extensor compartment for de Quervain’s tenosynovitis.

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Mark H. Greenberg

  2. Division of Rheumatology, Columbia VA Health Care System, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Alvin Lee Day

  3. Department of Medicine, Division of Rheumatology, Advocate Christ Medical Center, Advocate Medical Group, Chicago, IL, USA

    Suliman Alradawi

Authors
  1. Mark H. Greenberg
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  2. Alvin Lee Day
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  3. Suliman Alradawi
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Correspondence to Mark H. Greenberg .

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Greenberg, M.H., Day, A.L., Alradawi, S. (2023). Hand Arthropathies. In: Manual of Musculoskeletal Ultrasound . Springer, Cham. https://doi.org/10.1007/978-3-031-37416-6_5

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