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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

a Long axis (sagittal) view of the flexor aspect of the metacarpo-phalangeal joint. The flexor tendons (asterisks) are lying on the anterior aspect of the joint capsule (arrowheads) held in place by the cribriform (c) pulley (open arrowhead). The volar plate (arrow) and articular cartilage of the metacarpal head (open arrow) are visible. Extensor aspect in full extension (b) and flexion (c). Flexing the MCPJ compresses the connective tissue in the proximal recess (between arrowheads) and may make subtle synovial thickening more conspicuous. MC metacarpal, PP proximal phalanx
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Fig3: a Long axis (sagittal) view of the flexor aspect of the metacarpo-phalangeal joint. The flexor tendons (asterisks) are lying on the anterior aspect of the joint capsule (arrowheads) held in place by the cribriform (c) pulley (open arrowhead). The volar plate (arrow) and articular cartilage of the metacarpal head (open arrow) are visible. Extensor aspect in full extension (b) and flexion (c). Flexing the MCPJ compresses the connective tissue in the proximal recess (between arrowheads) and may make subtle synovial thickening more conspicuous. MC metacarpal, PP proximal phalanx

Mentions: A sagittal image of the palmar aspect of the metacarpo-phalangeal joint is shown in Fig. 3. Note the presence of a layer of contact gel between the probe and the underlying skin (Fig. 3b). This provides good resolution of skin and subcutaneous tissues, as well as reducing the amount of probe pressure, which can interfere with the assessment of subtle joint effusion and blood flow. Abnormalities in the superficial layers include increased thickness in psoriatic arthritis and calcification.Fig. 3


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

McNally EG - Skeletal Radiol. (2007)

a Long axis (sagittal) view of the flexor aspect of the metacarpo-phalangeal joint. The flexor tendons (asterisks) are lying on the anterior aspect of the joint capsule (arrowheads) held in place by the cribriform (c) pulley (open arrowhead). The volar plate (arrow) and articular cartilage of the metacarpal head (open arrow) are visible. Extensor aspect in full extension (b) and flexion (c). Flexing the MCPJ compresses the connective tissue in the proximal recess (between arrowheads) and may make subtle synovial thickening more conspicuous. MC metacarpal, PP proximal phalanx
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: a Long axis (sagittal) view of the flexor aspect of the metacarpo-phalangeal joint. The flexor tendons (asterisks) are lying on the anterior aspect of the joint capsule (arrowheads) held in place by the cribriform (c) pulley (open arrowhead). The volar plate (arrow) and articular cartilage of the metacarpal head (open arrow) are visible. Extensor aspect in full extension (b) and flexion (c). Flexing the MCPJ compresses the connective tissue in the proximal recess (between arrowheads) and may make subtle synovial thickening more conspicuous. MC metacarpal, PP proximal phalanx
Mentions: A sagittal image of the palmar aspect of the metacarpo-phalangeal joint is shown in Fig. 3. Note the presence of a layer of contact gel between the probe and the underlying skin (Fig. 3b). This provides good resolution of skin and subcutaneous tissues, as well as reducing the amount of probe pressure, which can interfere with the assessment of subtle joint effusion and blood flow. Abnormalities in the superficial layers include increased thickness in psoriatic arthritis and calcification.Fig. 3

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