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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

Stenosing tenosynovitis of FPL tendon/trigger thumb (A-D). Long (A) and short (B and C) axis ultrasound images along the volar aspect of the thumb showing thickened A1 pulley of the thumb (white arrow) with increased vascularity (open arrow) within the thickened pulley and tendon thickening (red arrow). Long axis ultrasound image (D) along the volar aspect of the thumb shows ganglion cysts (open arrow) in the volar aspect of the flexor pollicis longus tendon along with thickened A1 pulley (white arrow). (FPL - F)
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Figure 11: Stenosing tenosynovitis of FPL tendon/trigger thumb (A-D). Long (A) and short (B and C) axis ultrasound images along the volar aspect of the thumb showing thickened A1 pulley of the thumb (white arrow) with increased vascularity (open arrow) within the thickened pulley and tendon thickening (red arrow). Long axis ultrasound image (D) along the volar aspect of the thumb shows ganglion cysts (open arrow) in the volar aspect of the flexor pollicis longus tendon along with thickened A1 pulley (white arrow). (FPL - F)

Mentions: Trigger thumb is a transient locking of the thumb in flexion, followed by a painful snapping sensation during extension. This occurs due to stenosing tenosynovitis at the level of the pulley (most common A1). Ultrasound [Figure 11] shows a thickened pulley, local swelling of the flexor tendons distal to the pulley, distal tenosynovitis, and small cysts at the pulley boundaries due to fluid trapping. In severe cases, dynamic scanning during passive flexion and extension shows difficult tendon gliding underneath the abnormal pulley [Video 5]. Doppler imaging may depict a hypervascular pattern in the pulley with surrounding soft tissues.[7] It is unclear if thickening of the A1 pulley initiates the blockage and tendon inflammation or if the thickening is secondary to tendinopathy.[8] Treatment is often corticosteroid injection near the level of the pulley or in the tendon sheath[9] and can be performed under ultrasound guidance. Failed conservative management may require surgical release.[10] Ultrasound-guided release using a bent 19 or 25 G hypodermic needle has been described.[11]


Thumb ultrasound: Technique and pathologies
Stenosing tenosynovitis of FPL tendon/trigger thumb (A-D). Long (A) and short (B and C) axis ultrasound images along the volar aspect of the thumb showing thickened A1 pulley of the thumb (white arrow) with increased vascularity (open arrow) within the thickened pulley and tendon thickening (red arrow). Long axis ultrasound image (D) along the volar aspect of the thumb shows ganglion cysts (open arrow) in the volar aspect of the flexor pollicis longus tendon along with thickened A1 pulley (white arrow). (FPL - F)
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5036340&req=5

Figure 11: Stenosing tenosynovitis of FPL tendon/trigger thumb (A-D). Long (A) and short (B and C) axis ultrasound images along the volar aspect of the thumb showing thickened A1 pulley of the thumb (white arrow) with increased vascularity (open arrow) within the thickened pulley and tendon thickening (red arrow). Long axis ultrasound image (D) along the volar aspect of the thumb shows ganglion cysts (open arrow) in the volar aspect of the flexor pollicis longus tendon along with thickened A1 pulley (white arrow). (FPL - F)
Mentions: Trigger thumb is a transient locking of the thumb in flexion, followed by a painful snapping sensation during extension. This occurs due to stenosing tenosynovitis at the level of the pulley (most common A1). Ultrasound [Figure 11] shows a thickened pulley, local swelling of the flexor tendons distal to the pulley, distal tenosynovitis, and small cysts at the pulley boundaries due to fluid trapping. In severe cases, dynamic scanning during passive flexion and extension shows difficult tendon gliding underneath the abnormal pulley [Video 5]. Doppler imaging may depict a hypervascular pattern in the pulley with surrounding soft tissues.[7] It is unclear if thickening of the A1 pulley initiates the blockage and tendon inflammation or if the thickening is secondary to tendinopathy.[8] Treatment is often corticosteroid injection near the level of the pulley or in the tendon sheath[9] and can be performed under ultrasound guidance. Failed conservative management may require surgical release.[10] Ultrasound-guided release using a bent 19 or 25 G hypodermic needle has been described.[11]

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