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Ultrasound of the small joints of the hands and feet: current status.

McNally EG - Skeletal Radiol. (2007)

Bottom Line: The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques.Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuffield Orthopaedic Centre, Old Road, Oxford OX3 7LD, UK. eugene.mcnally@ndos.ox.ac.uk

ABSTRACT
The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. Ultrasound machines with high-resolution surface probes are readily available in most radiology departments and can be used to address important clinical questions posed by the rheumatologist and sports and rehabilitation physician. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spaced joints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety. Contrast-enhanced magnetic resonance provides a better measure of capillary permeability and extracellular fluid than does ultrasound. The ability to image simultaneously multiple small joints in the hands and feet and their enhancement characteristics cannot be matched with ultrasound, though future developments in 3-D ultrasound may narrow this gap. Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

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Related in: MedlinePlus

Position for examination of the hands. The probe is in position for a sagittal examination of the metacarpo-phalangeal joint (MCPJ) on the extensor (a) and flexor (b) sides. The probe is held between thumb and forefinger, with the ulnar border of the hand used as support (arrow). Note the liberal quantity of gel used to provide some stand-off (arrowhead). c Position for examination of radial aspect of second MCPJ. d Probe position to examine the collateral ligaments and lateral compartments of the interphalangeal joints
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Fig1: Position for examination of the hands. The probe is in position for a sagittal examination of the metacarpo-phalangeal joint (MCPJ) on the extensor (a) and flexor (b) sides. The probe is held between thumb and forefinger, with the ulnar border of the hand used as support (arrow). Note the liberal quantity of gel used to provide some stand-off (arrowhead). c Position for examination of radial aspect of second MCPJ. d Probe position to examine the collateral ligaments and lateral compartments of the interphalangeal joints

Mentions: The hands are best examined with the patient and examiner seated. The examination table is adjusted to a comfortable height for both, taking account of coexistent shoulder and elbow disease. The examiner sits at 90° to the patient, giving easy access to both the patient and the ultrasound controls. Good contact and near field resolution require liberal quantities of contact jelly, preferably warmed to body temperature (Fig. 1). Many gel stand-off pads are rather awkward and can limit access to the lateral recesses of small joints; soft pads work best. Some operators like to immerse the patient’s hand in warm water; if this method is used, it is preferable to leave the water to stand for some while so that all air bubbles are dissipated.Fig. 1


Ultrasound of the small joints of the hands and feet: current status.

McNally EG - Skeletal Radiol. (2007)

Position for examination of the hands. The probe is in position for a sagittal examination of the metacarpo-phalangeal joint (MCPJ) on the extensor (a) and flexor (b) sides. The probe is held between thumb and forefinger, with the ulnar border of the hand used as support (arrow). Note the liberal quantity of gel used to provide some stand-off (arrowhead). c Position for examination of radial aspect of second MCPJ. d Probe position to examine the collateral ligaments and lateral compartments of the interphalangeal joints
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2141652&req=5

Fig1: Position for examination of the hands. The probe is in position for a sagittal examination of the metacarpo-phalangeal joint (MCPJ) on the extensor (a) and flexor (b) sides. The probe is held between thumb and forefinger, with the ulnar border of the hand used as support (arrow). Note the liberal quantity of gel used to provide some stand-off (arrowhead). c Position for examination of radial aspect of second MCPJ. d Probe position to examine the collateral ligaments and lateral compartments of the interphalangeal joints
Mentions: The hands are best examined with the patient and examiner seated. The examination table is adjusted to a comfortable height for both, taking account of coexistent shoulder and elbow disease. The examiner sits at 90° to the patient, giving easy access to both the patient and the ultrasound controls. Good contact and near field resolution require liberal quantities of contact jelly, preferably warmed to body temperature (Fig. 1). Many gel stand-off pads are rather awkward and can limit access to the lateral recesses of small joints; soft pads work best. Some operators like to immerse the patient’s hand in warm water; if this method is used, it is preferable to leave the water to stand for some while so that all air bubbles are dissipated.Fig. 1

Bottom Line: The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques.Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuffield Orthopaedic Centre, Old Road, Oxford OX3 7LD, UK. eugene.mcnally@ndos.ox.ac.uk

ABSTRACT
The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. Ultrasound machines with high-resolution surface probes are readily available in most radiology departments and can be used to address important clinical questions posed by the rheumatologist and sports and rehabilitation physician. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spaced joints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety. Contrast-enhanced magnetic resonance provides a better measure of capillary permeability and extracellular fluid than does ultrasound. The ability to image simultaneously multiple small joints in the hands and feet and their enhancement characteristics cannot be matched with ultrasound, though future developments in 3-D ultrasound may narrow this gap. Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

Show MeSH
Related in: MedlinePlus