Limits...
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.

Show MeSH

Related in: MedlinePlus

Iatrogenic synovtis (arrowheads) of the carpo-metacarpal joint due to silastic implant (arrow)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2141652&req=5

Fig2: Iatrogenic synovtis (arrowheads) of the carpo-metacarpal joint due to silastic implant (arrow)

Mentions: For a routine rheumatological examination of the hand, the author examines the second to fifth rays. The first ray is included only in specific clinical situations (Fig. 2). The extensor side of the metacarpo-phalangeal joints are examined first, followed by the extensor, ulnar and, in particular, the radial aspects of the IPJs, as indicated (Fig. 1). The dorsal aspects of the wrist and extensor tendons are studied before turning to the palmar side. The flexor aspect of the metacarpophalangeal and proximal interphalangeal joints are examined, with particular attention paid to those that have been normal on the extensor side.Fig. 2


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

McNally EG - Skeletal Radiol. (2007)

Iatrogenic synovtis (arrowheads) of the carpo-metacarpal joint due to silastic implant (arrow)
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Iatrogenic synovtis (arrowheads) of the carpo-metacarpal joint due to silastic implant (arrow)
Mentions: For a routine rheumatological examination of the hand, the author examines the second to fifth rays. The first ray is included only in specific clinical situations (Fig. 2). The extensor side of the metacarpo-phalangeal joints are examined first, followed by the extensor, ulnar and, in particular, the radial aspects of the IPJs, as indicated (Fig. 1). The dorsal aspects of the wrist and extensor tendons are studied before turning to the palmar side. The flexor aspect of the metacarpophalangeal and proximal interphalangeal joints are examined, with particular attention paid to those that have been normal on the extensor side.Fig. 2

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