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Thumb ultrasound: Technique and pathologies

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

No MeSH data available.


Related in: MedlinePlus

Proximal and distal intersection points with distal intersection syndrome (A-C). Schematic diagram (A) shows the 1st extensor compartment tendons (brown) crossing over the 2nd extensor compartment tendons (yellow)—proximal intersection point (red circle). Schematic diagram (B) shows the extensor pollicis longus (EPL) tendon (grey) crossing over 2nd extensor compartment tendons (yellow) - distal intersection point (red circle). Short axis (C) ultrasound showing the tendon (white arrow) crossing over the 2nd extensor compartment tendons (open arrow) associated with tendon sheath thickening (red arrow)
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Figure 4: Proximal and distal intersection points with distal intersection syndrome (A-C). Schematic diagram (A) shows the 1st extensor compartment tendons (brown) crossing over the 2nd extensor compartment tendons (yellow)—proximal intersection point (red circle). Schematic diagram (B) shows the extensor pollicis longus (EPL) tendon (grey) crossing over 2nd extensor compartment tendons (yellow) - distal intersection point (red circle). Short axis (C) ultrasound showing the tendon (white arrow) crossing over the 2nd extensor compartment tendons (open arrow) associated with tendon sheath thickening (red arrow)

Mentions: The extensor tendons of the thumb are situated in the 1st (abductor pollicis longus and extensor pollicis brevis – APL and EPB) and 3rd (extensor pollicis longus – EPL) extensor compartments on the dorsal aspect of the wrist. These tendons should be first located and then traced proximally up to the myotendinous junction and distally to their insertion. To identify the extensor tendons locate Lister's tubercle [Figure 3E–G] on the dorsal aspect of the wrist, the tendon in its medial aspect is EPL (3rd extensor compartment) and the tendons in its lateral aspect are extensor carpi radialis longus and brevis (2nd extensor compartment) and APL and EPB (1st extensor compartment) [Figure 3H and I]. After slight supination of the hand (karate chop position), the 1st extensor compartment tendons are traced proximally, where they cross over the 2nd compartment muscles (proximal intersection point) [Figure 4A]. The EPL (3rd compartment) tendon is traced distally, where it crosses 2nd extensor compartment tendons (distal intersection point) [Figure 4B]. Because of the mechanical friction at the level of these crossings, changes of tendinosis, peritendinous edema with loss of intervening fat and tendon tear can occur, which is referred to as the intersection syndrome [Video 1] and [Figure 4C].


Thumb ultrasound: Technique and pathologies
Proximal and distal intersection points with distal intersection syndrome (A-C). Schematic diagram (A) shows the 1st extensor compartment tendons (brown) crossing over the 2nd extensor compartment tendons (yellow)—proximal intersection point (red circle). Schematic diagram (B) shows the extensor pollicis longus (EPL) tendon (grey) crossing over 2nd extensor compartment tendons (yellow) - distal intersection point (red circle). Short axis (C) ultrasound showing the tendon (white arrow) crossing over the 2nd extensor compartment tendons (open arrow) associated with tendon sheath thickening (red arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 4: Proximal and distal intersection points with distal intersection syndrome (A-C). Schematic diagram (A) shows the 1st extensor compartment tendons (brown) crossing over the 2nd extensor compartment tendons (yellow)—proximal intersection point (red circle). Schematic diagram (B) shows the extensor pollicis longus (EPL) tendon (grey) crossing over 2nd extensor compartment tendons (yellow) - distal intersection point (red circle). Short axis (C) ultrasound showing the tendon (white arrow) crossing over the 2nd extensor compartment tendons (open arrow) associated with tendon sheath thickening (red arrow)
Mentions: The extensor tendons of the thumb are situated in the 1st (abductor pollicis longus and extensor pollicis brevis – APL and EPB) and 3rd (extensor pollicis longus – EPL) extensor compartments on the dorsal aspect of the wrist. These tendons should be first located and then traced proximally up to the myotendinous junction and distally to their insertion. To identify the extensor tendons locate Lister's tubercle [Figure 3E–G] on the dorsal aspect of the wrist, the tendon in its medial aspect is EPL (3rd extensor compartment) and the tendons in its lateral aspect are extensor carpi radialis longus and brevis (2nd extensor compartment) and APL and EPB (1st extensor compartment) [Figure 3H and I]. After slight supination of the hand (karate chop position), the 1st extensor compartment tendons are traced proximally, where they cross over the 2nd compartment muscles (proximal intersection point) [Figure 4A]. The EPL (3rd compartment) tendon is traced distally, where it crosses 2nd extensor compartment tendons (distal intersection point) [Figure 4B]. Because of the mechanical friction at the level of these crossings, changes of tendinosis, peritendinous edema with loss of intervening fat and tendon tear can occur, which is referred to as the intersection syndrome [Video 1] and [Figure 4C].

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

No MeSH data available.


Related in: MedlinePlus