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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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Coronal image of the second metacarpo-phalangeal joint, showing the radial collateral ligament (arrow). MC metacarpal, PP proximal phalanx
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Fig4: Coronal image of the second metacarpo-phalangeal joint, showing the radial collateral ligament (arrow). MC metacarpal, PP proximal phalanx

Mentions: The joint capsule on the flexor side is reinforced by several connective tissue structures, which can be identified on ultrasound. The collateral ligament runs obliquely from posterolateral to anterolateral and is best appreciated on coronal images (Fig. 1). The accessory collateral ligament has its origin on the head of the proximal phalanx, between the collateral ligament and volar plate, with an insertion on the volar plate itself (Fig. 4). The volar plate is a centrally positioned fibrocartilagenous structure that has a broad-based attachment to the base of the proximal phalanx (Fig. 3). It inserts by two slips onto the neck of the adjacent metacarpal. These are called the check-rein ligaments. Within the joint, the proximal recess on the flexor aspect of the metacarpo-phalangeal joints is identified. Overlying this is the capsule of the MCP joint, which inserts on the adjacent metacarpal neck some distance from the joint surface. Hyporeflective articular cartilage is identified deep to the volar plate on the metacarpal head.Fig. 4


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

McNally EG - Skeletal Radiol. (2007)

Coronal image of the second metacarpo-phalangeal joint, showing the radial collateral ligament (arrow). MC metacarpal, PP proximal phalanx
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: Coronal image of the second metacarpo-phalangeal joint, showing the radial collateral ligament (arrow). MC metacarpal, PP proximal phalanx
Mentions: The joint capsule on the flexor side is reinforced by several connective tissue structures, which can be identified on ultrasound. The collateral ligament runs obliquely from posterolateral to anterolateral and is best appreciated on coronal images (Fig. 1). The accessory collateral ligament has its origin on the head of the proximal phalanx, between the collateral ligament and volar plate, with an insertion on the volar plate itself (Fig. 4). The volar plate is a centrally positioned fibrocartilagenous structure that has a broad-based attachment to the base of the proximal phalanx (Fig. 3). It inserts by two slips onto the neck of the adjacent metacarpal. These are called the check-rein ligaments. Within the joint, the proximal recess on the flexor aspect of the metacarpo-phalangeal joints is identified. Overlying this is the capsule of the MCP joint, which inserts on the adjacent metacarpal neck some distance from the joint surface. Hyporeflective articular cartilage is identified deep to the volar plate on the metacarpal head.Fig. 4

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