1
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Bayer T, Bächter L, Lutter C, Janka R, Uder M, Schöffel V, Roemer FW, Nagel AM, Heiss R. Comparison of 3T and 7T magnetic resonance imaging for direct visualization of finger flexor pulley rupture: an ex-vivo study. Skeletal Radiol 2024:10.1007/s00256-024-04671-x. [PMID: 38607418 DOI: 10.1007/s00256-024-04671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To compare image quality and diagnostic performance of 3T and 7T magnetic resonance imaging (MRI) for direct depiction of finger flexor pulleys A2, A3 and A4 before and after artificial pulley rupture in an ex-vivo model using anatomic preparation as reference. MATERIALS AND METHODS 30 fingers from 10 human cadavers were examined at 3T and 7T before and after being subjected to iatrogenic pulley rupture. MRI protocols were comparable in duration, both lasting less than 22 min. Two experienced radiologists evaluated the MRIs. Image quality was graded according to a 4-point Likert scale. Anatomic preparation was used as gold standard. RESULTS In comparison, 7T versus 3T had a sensitivity and specificity for the detection of A2, A3 and A4 pulley lesions with 100% vs. 95%, respectively 98% vs. 100%. In the assessment of A3 pulley lesions sensitivity of 7T was superior to 3T MRI (100% vs. 83%), whereas specificity was lower (95% vs. 100%). Image quality assessed before and after iatrogenic rupture was comparable with 2.74 for 7T and 2.61 for 3T. Visualization of the A3 finger flexor pulley before rupture creation was significantly better for 7 T (p < 0.001). Interobserver variability showed substantial agreement at 3T (κ = 0.80) and almost perfect agreement at 7T (κ = 0.90). CONCLUSION MRI at 3T allows a comparable diagnostic performance to 7T for direct visualization and characterization of finger flexor pulleys before and after rupture, with superiority of 7T MRI in the visualization of the normal A3 pulley.
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Affiliation(s)
- Thomas Bayer
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
- Klinikum Fürth, Institute of Neuroradiology and Radiology, Fürth, Germany.
| | - Lilly Bächter
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
- School of Health, Leeds Becket University, Leeds, UK
| | - Rolf Janka
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Völker Schöffel
- Department of Sports Orthopaedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamberg, Germany
- Department of Orthopedic and Trauma Surgery, Friedrich Alexander Universität Erlangen-Nürnberg, FRG, Erlangen, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- School of Health, Leeds Becket University, Leeds, UK
| | - Frank W Roemer
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- School of Medicine, Chobanian & Avedisian Boston University, Boston, MA, USA
| | - Armin M Nagel
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Rafael Heiss
- Institue of Radiology, Universitätsklinikum & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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2
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Flores DV, Murray T, Jacobson JA. Diagnostic and Interventional US of the Wrist and Hand: Quadrant-based Approach. Radiographics 2023; 43:e230046. [PMID: 37498783 DOI: 10.1148/rg.230046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Diagnostic and interventional US of the wrist and hand can be challenging due to the small size and superficial location of structures and various disorders that need to be considered. A quadrant-based approach (volar, ulnar, dorsal, and radial) provides a rational method for performing a focused examination and joint positioning during both diagnostic imaging and intervention. Volar wrist disorders primarily involve the median nerve and the digital flexor system comprised of the flexor tendons and pulleys. The ulnar nerve and extensor carpi ulnaris tendon are chiefly responsible for ulnar-sided wrist pain. The differential diagnosis for dorsal-sided symptoms typically involves the extensor tendon compartments and includes distal intersection syndrome, extensor pollicis longus tear, and digital extensor apparatus injury. The soft-tissue ganglion is the most common abnormality in the dorsal wrist, typically associated with wrist ligaments or joint capsule. Radial-sided pain may be secondary to de Quervain tenosynovitis and must be differentiated from the more proximal intersection syndrome. US is an important tool for assessing the ulnar collateral ligament of the first metacarpophalangeal joint of the thumb and differentiating between displaced and nondisplaced tears, thereby influencing management. Despite the complexity of the anatomy and potential pathologic features within the wrist, a focused quadrant-based examination can permit the sonologist to focus on the structures of relevance. In conjunction with a systematic approach, this can aid in precise and efficient diagnostic scanning and intervention of the wrist and hand. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Timothy Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
| | - Jon A Jacobson
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (T.M.); Lenox Hill Radiology and Medical Imaging, New York, NY (J.A.J.); and Department of Radiology, University of California-San Diego, San Diego, Calif (J.A.J.)
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3
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Iruretagoiena X, Schöffl V, Balius R, Blasi M, Dávila F, Sala X, Sancho I, De La Fuente J. High-resolution ultrasound tendon-to-bone distances in partial and complete finger flexor A2 pulley ruptures simulated in human cadaver dissection: toward understanding imaging of partial pulley ruptures. Front Bioeng Biotechnol 2023; 11:1123857. [PMID: 37351474 PMCID: PMC10282126 DOI: 10.3389/fbioe.2023.1123857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction: The A2 pulley tear is the most common injury in rock climbing. Whereas complete A2 pulley ruptures have been extensively researched, studies focused on partial A2 pulley ruptures are lacking. A2 pulleys rupture distally to proximally. High-resolution ultrasound imaging is considered the gold-standard tool for diagnosis and the most relevant ultrasound measurement is the tendon-to-bone distance (TBD), which increases when the pulley ruptures. The purpose of this study was to establish tendon-to-bone distance values for different sizes of partial A2 pulley ruptures and compare these values with those of complete ruptures. Material and methods: The sample consisted of 30 in vitro fingers randomly assigned to 5 groups: G1, no simulated tear (control); G2, simulated 5 mm tear (low-grade partial rupture); G3, simulated 10 mm tear (medium-grade partial rupture); G4, simulated 15 mm tear (high-grade partial rupture); and G5, simulated 20 mm or equivalent tear (complete rupture). A highly experienced sonographer blinded to the randomization process and dissections examined all fingers. Results: The tendon-to-bone distance measurements (medians and interquartile ranges) were as follows: G1, 0.95 mm (0.77-1.33); G2, 2.11 mm (1.78-2.33); G3, 2.28 mm (1.95-2.42); G4, 3.06 mm (2.79-3.28); and G5, 3.66 mm (3.55-4.76). Significant differences were found between non-torn pulleys and simulated partial and complete pulley ruptures. Discussion: In contrast, and inconsistent with other findings, no significant differences were found among the different partial rupture groups. In conclusion, the longer the partial pulley rupture, the higher the tendon-to-bone distance value. The literature is inconsistent regarding the tendon-to-bone distance threshold to diagnose a partial A2 pulley rupture. The minimum tendon-to-bone distance value for a partial rupture was 1.6 mm, and tendon-to-bone distance values above 3 mm suggest a high-grade partial pulley rupture (15 mm incision) or a complete pulley rupture.
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Affiliation(s)
- Xeber Iruretagoiena
- Deusto Physical TherapIker, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, San Sebastián, Spain
- Eskura Osasun Zentroa, Beasain, Spain
- Sputnik Investigación, Madrid, Spain
| | - Volker Schöffl
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, United States
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, United Kingdom
| | - Ramón Balius
- Consell Catala de l´Esport, Generalitat de Catalunya, Barcelona, Spain
- Sport Medicine and Imaging Department, Clínica Diagonal, Barcelona, Spain
| | - Marc Blasi
- Department of Plastic Surgery, Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Xavier Sala
- Anatomy and Embryology Department, School of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Anesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Igor Sancho
- Deusto Physical TherapIker, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, San Sebastián, Spain
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4
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Kwon BY, Kim D, Kim YJ, Jun D, Lee JH. Isolated A1 Pulley Rupture of Left Middle Finger in Baseball Player: Case Report. Curr Sports Med Rep 2022; 21:358-361. [DOI: 10.1249/jsr.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Case reports on bone avulsion in closed flexor pulley injury: a new or neglected radiological finding? HAND SURGERY & REHABILITATION 2022; 41:523-525. [DOI: 10.1016/j.hansur.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
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6
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Berrigan W, White W, Cipriano K, Wickstrom J, Smith J, Hager N. Diagnostic Imaging of A2 Pulley Injuries: A Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1047-1059. [PMID: 34342037 PMCID: PMC9292555 DOI: 10.1002/jum.15796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 05/29/2023]
Abstract
Injury to the A2 pulley is caused by high eccentric forces on the flexor-tendon-pulley system. Accurate diagnosis is necessary to identify the most appropriate treatment options. This review summarizes the literature with respect to using ultrasound (US) to diagnose A2 pulley injuries, compares ultrasound to magnetic resonance imaging and computed tomography, and identifies current knowledge gaps. The results suggest that US should be used as the primary imaging modality given high accuracy, relatively low cost, ease of access, and dynamic imaging capabilities. Manual resistance is beneficial to accentuate bowstringing, but further research is needed to determine best positioning for evaluation.
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Affiliation(s)
- William Berrigan
- Department of OrthopaedicsEmory University School of MedicineAtlantaGeorgiaUSA
| | - William White
- Department of Rehabilitation MedicineMedstar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Kevin Cipriano
- Department of Rehabilitation MedicineMedstar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Jordan Wickstrom
- Department of BiomechanicsUniversity of Nebraska at OmahaOmahaNebraskaUSA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Radiology, and Clinical AnatomyMayo ClinicRochesterMinnesotaUSA
| | - Nelson Hager
- Department of Physical Medicine and RehabilitationUniformed Services University of the Health SciencesBethesdaMarylandUSA
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7
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Apard T. Flexor Tendons Sonography. Hand Clin 2022; 38:31-34. [PMID: 34802606 DOI: 10.1016/j.hcl.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasonography is the best examination to explore the flexor tendons anatomy and disorders from the wrist to the digit. It is the only dynamic and comparative tool easily accessible for the surgeon. Indeed, ultrasonography is always available in all the departments of your hospital. Recent innovations permit to see superficially (high-frequency probes), precisely (smaller probes), and with greater softwares for an effective Doppler mode. Ultrasonography becomes a very important help at the outpatient clinic examination. In the future it can be used in the operating room to perform miniinvasive surgery under local anesthesia to control active motion of the gliding of flexor tendons.
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Affiliation(s)
- Thomas Apard
- Ultrasound Hand Surgery Center, 2 rue de Tocqueville Versailles, France.
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8
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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9
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Díaz HFS, Fernández FD, Horcajadas ÁB, Martínez MV, Yubero MEC. Usefulness of the Ultrasound in Hand Surgery: Part I. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1739295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractIn the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office.The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit.Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome.The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients.
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Affiliation(s)
- Homid Fahandezh-Saddi Díaz
- Hand Surgery Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
- Orthopedic Surgery and Traumatology Unit, clínica AVANFI, Madrid, Madrid, Spain
| | - Fernando Dávila Fernández
- Orthopedic Surgery and Traumatology Unit, Clínica Pakea de Mutualia, Donostia/San Sebastián, Guipúzcoa, País Vasco, Spain
| | - Ángel Bueno Horcajadas
- Musculoskeletal Radiology Service, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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10
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Rosskopf AB, Martinoli C, Sconfienza LM, Gitto S, Taljanovic MS, Picasso R, Klauser A. Sonography of tendon pathology in the hand and wrist. J Ultrason 2021; 21:e306-e317. [PMID: 34970442 PMCID: PMC8678645 DOI: 10.15557/jou.2021.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022] Open
Abstract
Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high-quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.
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Affiliation(s)
- Andrea B Rosskopf
- Radiology, Balgrist University Hospital, University of Zurich, Switzerland.,Radiology, ARISTRA, Switzerland
| | - Carlo Martinoli
- Department of Health Science (DISSAL), Università di Genova, Italy.,IRCCS, Ospedale Policlinico San Martino, Italy
| | - Luca M Sconfienza
- IRCCS, Istituto Ortopedico Galeazzi, Italy.,Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Mihra S Taljanovic
- Department of Radiology, University of New Mexico, United States.,Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, United States
| | | | - Andrea Klauser
- Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Austria
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11
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MRI of Finger Pulleys at 7T-Direct Characterization of Pulley Ruptures in an Ex Vivo Model. Diagnostics (Basel) 2021; 11:diagnostics11071206. [PMID: 34359289 PMCID: PMC8303165 DOI: 10.3390/diagnostics11071206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate 7 Tesla (7T) magnetic resonance imaging (MRI) for direct visualization and specific characterization of the finger flexor pulleys A2, A3, and A4 before and after ex vivo pulley rupture. Thirty fingers of human cadavers were examined before and after pulley disruption with a 26 min clinical 7T pulse sequence protocol. Images were assessed by two experienced radiologists for the presence of pulley rupture. Injury characterization included definition of rupture location, morphology, and complications. Image quality was evaluated according to a 4-point Likert-type scale from “not evaluable” to “excellent”. Macroscopic preparations were used as the reference standard. Direct characterization of intact A2, A3, and A4 pulleys and the corresponding pulley lesions was possible in all cases. The rupture location was distributed equally at the radial, ulnar, and central parts of the pulleys. A dislocation and intercalation of the pulley stump between the flexor tendon and finger phalanges was observed as a complication in 62.5% of cases. The average Likert score for direct visualization of pulleys was 2.67 before rupture and 2.79 after rupture creation, demonstrating adequate image quality for routine application. 7T MRI enables a direct characterization of A2, A3, and A4 pulleys before and after artificial disruption, including the definition of rupture morphology and location as well as the detection of rupture complications. This promises a precise presurgical evaluation of pulley injuries and complicated pulley stump dislocations.
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Rosskopf AB, Taljanovic MS, Sconfienza LM, Gitto S, Martinoli C, Picasso R, Klauser A. Pulley, Flexor, and Extensor Tendon Injuries of the Hand. Semin Musculoskelet Radiol 2021; 25:203-215. [PMID: 34082447 DOI: 10.1055/s-0041-1727196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.
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Affiliation(s)
- Andrea B Rosskopf
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Radiology, ARISTRA, Zurich, Switzerland
| | - Mihra S Taljanovic
- Department of Medical Imaging, University of Arizona, Business, SimonMed Imaging, Scottsdale, Arizona
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Carlo Martinoli
- Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
| | - Riccardo Picasso
- Cattedra di Radiologia-DISC, Università di Genova, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Innsbruck, Austria
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13
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Viscoelastic properties of the human A2 finger pulley. Arch Orthop Trauma Surg 2021; 141:1073-1080. [PMID: 33550452 DOI: 10.1007/s00402-021-03781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Biomechanical evaluation of the viscoelastic properties tissue deformation, stiffness, and maximum breaking load of the human A2 pulley. We hypothesized that the A2 pulleys of index, middle, and ring fingers exhibit no difference regarding the aforementioned biomechanical parameters. METHODS Forty-one A2 pulleys of 14 upper extremities (8 body donors) were assessed. Cyclic and load-to-failure testing were performed. The biomechanical parameters tissue deformation during cyclic and load-to-failure testing, stiffness, and maximum breaking load were determined. RESULTS No significant differences between the fingers could be detected regarding the biomechanical parameters. A significant negative correlation could be detected between stiffness and deformation of the pulley. Significant positive correlations could be identified between stiffness and maximum breaking load and between maximum breaking load and deformation of the pulleys. CONCLUSIONS Assessment of the viscoelastic properties of the A2 finger pulley promotes precise diagnosis of pulley lesions and will help to optimize treatment.
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Miro PH, vanSonnenberg E, Sabb DM, Schöffl V. Finger Flexor Pulley Injuries in Rock Climbers. Wilderness Environ Med 2021; 32:247-258. [PMID: 33966972 DOI: 10.1016/j.wem.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Finger flexor pulley system injuries are the most common overuse injury in rock climbers. These injuries occur rarely outside of rock climbing, owing to the sport's unique biomechanical demands on the finger. As rock climbing continues to grow and earn recognition as a mainstream sport, an understanding of how to diagnose and treat these injuries also has become important. Our purpose is to describe current concepts in anatomy, biomechanics, clinical evaluation, imaging, prevention, and treatment strategies relating to finger flexor pulley system injuries. Our literature search was performed on PubMed with MeSH terms and keywords as subject headings to meet the objectives of this review. The "crimp grip" used in rock climbing is the mechanism for these injuries. The A2, A3, and A4 pulleys are at the highest risk of injury, especially when loaded eccentrically. Physical examination may reveal clinical "bowstringing," defined as the volar displacement of the flexor tendons from the phalanges; however, imaging is required for characterization of the underlying injury. Ultrasound is highly sensitive and specific for diagnosis and is recommended as the initial imaging technique of choice. Magnetic resonance imaging is recommended as an additional imaging study if ultrasound is inconclusive. Properly warming up increases the amount of physiologic bowstringing and is thought to prevent injury from occurring. Pulley injuries may be classified as grade I through IV. Conservative treatment, including immobilization, the H-tape method, and the use of a protective pulley splint, is recommended for grade I to III injuries. Surgical repair is reserved for grade IV injuries that are not amenable to conservative treatment.
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Affiliation(s)
- Paulo H Miro
- University of Arizona College of Medicine, Phoenix, AZ.
| | | | - Dylan M Sabb
- University of Arizona College of Medicine, Phoenix, AZ; University of California, Davis, Department of Family & Community Medicine, Sacramento, CA
| | - Volker Schöffl
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany; Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, FRG, Germany; Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO; School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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15
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[Finger injuries with a focus on ligamentous structures]. Radiologe 2021; 61:426-432. [PMID: 33852030 DOI: 10.1007/s00117-021-00839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ligamentous lesions of the fingers are common everyday injuries and usually the result of distortion or overloading. Numerous examination methods are available for dedicated radiological diagnosis of sometimes complex injury patterns. OBJECTIVES To review radiological diagnosis of the ligamentous structures of the finger joints including the presentation of anatomical, biomechanical and therapeutic aspects. MATERIALS AND METHODS Presentation of the anatomy and biomechanics as well as the most common trauma mechanisms of the ligamentous structures. Review of the literature, discussion of recent work and diagnostic expert recommendations. RESULTS The most relevant ligamentous structures are collateral ligaments, pulley ligaments, volar plates and tendons. The goal of radiologic diagnosis is to accurately define the injury pattern and to differentiate between simple and complicated ligamentous lesions. In unclear cases, magnetic resonance imaging (MRI) has become standard for further diagnostics, which may allow depiction of ligamentous structures in submillimetre resolution. CONCLUSIONS Today, differential diagnosis includes all radiological modalities, which ensures the determination of an adequate therapy and prevention of sequel at a high standard.
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Krastman P, Mathijssen NMC, Bierma-Zeinstra SMA, Kraan GA, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update. BMJ Open 2020; 10:e037810. [PMID: 33154046 PMCID: PMC7646346 DOI: 10.1136/bmjopen-2020-037810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist. METHODS Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted. RESULTS None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively. CONCLUSIONS There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Iruretagoiena-Urbieta X, De la Fuente-Ortiz de Zarate J, Rodríguez-López ES, Barceló-Galíndez P, Oliva-Pascual-Vaca Á, Otero-Campos Á, Blasi M. Ultrasonographic Diagnosis of A2 or A4 Flexor Tendon Pulley Injury: A Systematic Review. Wilderness Environ Med 2020; 31:498-505. [PMID: 33132034 DOI: 10.1016/j.wem.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/17/2020] [Accepted: 07/21/2020] [Indexed: 01/02/2023]
Abstract
A2 or A4 annular finger pulley tears are common injuries in rock climbers. This study reviews the measurement procedures used and tendon-to-bone distance data obtained on high-resolution ultrasound images when diagnosing isolated rupture of the A2 or A4 pulleys. Out of 3447 records extracted, only 7 remained after applying the exclusion criteria. In diagnosing a complete rupture, tendon-to-bone distance used varied widely from 1.9 to 5.1 mm for A2 and from 1.8 to 3.1 mm for A4. Our findings point to a lack of consensus diagnostic criteria for pulley injuries and identify technical details needing further research.
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Affiliation(s)
- Xeber Iruretagoiena-Urbieta
- Department of Physiotherapy, Universidad Camilo José Cela, Madrid, Spain; Eskura Osasun Zentroa, Beasain, Spain
| | | | | | | | | | | | - Marc Blasi
- Department of Plastic Surgery, Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain
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18
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Abstract
The anatomy of the wrist and hand is complex and contains numerous small structures. Magnetic resonance imaging (MRI) is often an ideal imaging modality in the assessment of various traumatic and pathologic conditions of this region, and it is frequently performed after initial radiographs. In this manuscript we describe the normal anatomy, imaging techniques, and MRI findings of various traumatic and pathologic conditions of the wrist and hand including occult fractures, osteonecrosis, ligamentous and tendon injuries, and entrapment neuropathies.
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Iruretagoiena-Urbieta X, De la Fuente-Ortiz de Zarate J, Blasi M, Obradó-Carriedo F, Ormazabal-Aristegi A, Rodríguez-López ES. Grip Force Measurement as a Complement to High-Resolution Ultrasound in the Diagnosis and Follow-Up of A2 and A4 Finger Pulley Injuries. Diagnostics (Basel) 2020; 10:diagnostics10040206. [PMID: 32276341 PMCID: PMC7235872 DOI: 10.3390/diagnostics10040206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/03/2023] Open
Abstract
The ability of finger flexors to generate force has been studied in relation to climbing performance. However, not much attention has been paid to the decrease in finger grip force in relation to annular pulley injuries. The purpose of the present study was to determine if an injured annular pulley implies a finger flexor force decrease, as well as its relation to clinical and sonographic changes. We performed an observational study in 39 rock climbers with A2 or A4 pulley injuries to the 3rd or 4th fingers. The variables considered were pain upon palpation, ultrasound tendon–bone distance, and finger grip strength decrease. Three rock climbing grip types were considered: the one finger crimp, open crimp, and close crimp. Injured rock climbers presented a decrease in finger grip strength compared to non-injured controls when performing a one finger crimp (p < 0.001). There exists a significant correlation between a tendon–bone distance at the level of the injured pulley and a decreased finger grip strength measured by performing a one finger crimp (p = 0.006). A decrease in finger grip strength could be considered in the diagnostic and follow-up process of A2 and A4 pulley injuries to the 3rd and 4th fingers.
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Affiliation(s)
- Xeber Iruretagoiena-Urbieta
- Department of Physical Therapy, Universidad Camilo José Cela, 28692 Madrid, Spain;
- Eskura Osasun Zentroa, 20200 Beasain, Spain
| | | | - Marc Blasi
- Plastic Surgery Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona (Barcelona), Spain;
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VIDEO: Dynamic Ultrasound Evaluation for Soft-Tissue Injuries of the Extremities: Hand, Wrist, and Ankle. AJR Am J Roentgenol 2020; 214:871. [PMID: 32045309 DOI: 10.2214/ajr.19.22040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.
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21
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Wu TT, Wu PT, Lee SY, Wu KC, Shao CJ, Chern TC, Su FC, Jou IM. Effect of metacarpophalangeal joint position on A1 pulley and flexor digitorum tendons in trigger digit. J Chin Med Assoc 2019; 82:778-781. [PMID: 31373924 DOI: 10.1097/jcma.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate and compare the cross-sectional area (CSA) of flexor digitorum tendons and the thickness of first annular (A1) pulleys between contralateral normal digits and trigger digits (TDs) at positions of finger flexion and extension using a noninvasive ultrasound system. METHODS Seventeen affected fingers of 17 patients (6 men and 11 women) with TDs in one hand, and 17 contralateral normal digits without trigger finger symptoms were examined. The sonographic appearances of flexor digitorum tendons and A1 pulleys were observed at two positions of metacarpophalangeal (MCP) joint flexion: 0° and 60°. RESULTS The findings of this study indicate that CSA of flexor digitorum tendons and A1 pulley thickness were significantly larger in both positions of 0° and 60° flexion of MCP joint compared with contralateral normal digits (p < 0.01). In TDs, there was a significantly thicker A1 pulley at 60° flexion of MCP joint than that at 0° flexion (p < 0.01), but no significant change on CSA of flexor tendons. CONCLUSION Our results suggested that TDs lead to the thicker A1 pulley and larger CSA of the flexor digitorum tendons. The mismatch in volume change between CSA of flexor digitorum tendons and A1 pulley thickness during MCP flexion may lead to the trigger phenomenon.
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Affiliation(s)
- Tung-Tai Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
- Great East Gate Orthopedic Clinic, Tainan, Taiwan, ROC
| | - Po-Ting Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, YunLin, Taiwan, ROC
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Su-Ya Lee
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Kuo-Chen Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Orthopedics, Kuo's General Maunicipal Hospital, Tainan, Taiwan, ROC
| | - Chung-Jung Shao
- Department of Orthopedics, Tainan Maunicipal Hospital, Tainan, Taiwan, ROC
| | | | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan, ROC
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC
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22
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Efficacy of corticosteroid injection in rock climber's tenosynovitis. HAND SURGERY & REHABILITATION 2019; 38:317-322. [DOI: 10.1016/j.hansur.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 01/03/2023]
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Schellhammer F, Vantorre A. Semi-dynamic MRI of climbing-associated injuries of the finger. Skeletal Radiol 2019; 48:1435-1437. [PMID: 31037344 DOI: 10.1007/s00256-019-03216-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Injuries of the flexor-tendon-pulley system are common in rock climbers. The status of the A3 pulley ligament is crucial for grading such injuries. As standard MRI may miss lesions of the A3 pulley ligament, we introduce a semi-dynamic MRI sequence. MATERIALS AND METHODS Twenty-two fingers (14 volunteers, 3 injured climbers) were scanned using a sagittal T1 turbo spin echo sequence (repetition time: 400 ms, echo time: 14 ms, slice thickness: 5 mm) in six consecutive finger positions from stretched to maximum possible flexion. RESULTS No pulley lesion was found in volunteers. Bowstringing was detected in 3 injured fingers including the A3 pulley. CONCLUSION Semi-dynamic MRI is an technique that is easy to perform to identify injuries of the A3 pulley ligament that were not seen on standard imaging.
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Affiliation(s)
- Frank Schellhammer
- Diagnostic and Interventional Radiology, Krankenhaus der Augustinerinnen Köln, Jakobstrasse 27-31, 50678, Cologne, Germany.
| | - Andreas Vantorre
- Network of Sports Medicine in Rock Climbing, Dietrichstrasse 18, 60439, Frankfurt, Germany
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24
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Torabi M, Lenchik L, Beaman FD, Wessell DE, Bussell JK, Cassidy RC, Czuczman GJ, Demertzis JL, Khurana B, Klitzke A, Motamedi K, Pierce JL, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16:S7-S17. [DOI: 10.1016/j.jacr.2019.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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25
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Sonographic imaging of hand and wrist injuries: applications in the ER setting. Emerg Radiol 2018; 26:227-240. [DOI: 10.1007/s10140-018-1649-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/26/2018] [Indexed: 01/14/2023]
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26
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Sirlyn Q, Bird S. Ultrasound of flexor digitorum apparatus in acute and chronic pathology. SONOGRAPHY 2018. [DOI: 10.1002/sono.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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Hoff MN, Greenberg TD. MRI sport-specific pulley imaging. Skeletal Radiol 2018; 47:989-992. [PMID: 29018907 DOI: 10.1007/s00256-017-2786-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/11/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aim to create a novel MRI methodology that employs sport-specific stress views for imaging finger pulley injuries in the evaluation of post-operative healing effectiveness. The goal is to measure the bone to tendon distance (BTD), which is the current standard for determining pulley injuries. MATERIALS AND METHODS The athlete was imaged in a crimp-grip stressed position to emulate sport-specific biomechanics. A Gradient Echo technique was modified to maximize the signal to noise ratio and minimize distortion near the bone and tendon, simplifying the determination of the BTD. RESULTS A stress-crimped hand position is imaged in less than one half-minute to enable diagnostic visualization of a normal proximal phalanx' bone and tendon via measurement of their BTD. CONCLUSION This novel stress methodology allows for sport-specific imaging, which is ideal for determining functional compromise of the hand's pulley mechanism. Surgical outcomes may be more sensitively compared when using stress views, and these comparisons may then direct optimal repair technique. Future studies will utilize this technique to attempt early-stage detection of pulley injuries prior to complete rupture.
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Affiliation(s)
- Michael N Hoff
- Diagnostic Physics, Department of Radiology, University of Washington Medicine, 222F Portage Bay Building, Box 357987, Seattle, WA, 98195-7987, USA
| | - Todd D Greenberg
- Department of Radiology, University of Washington Medicine Eastside Specialty Center, 3100 Northup Way, Bellevue, WA, 98004, USA.
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Gitto S, Draghi AG, Draghi F. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:51-68. [PMID: 28708327 DOI: 10.1002/jum.14313] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
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Bayer T, Adler W, Janka R, Uder M, Roemer F. Magnetic resonance cinematography of the fingers: a 3.0 Tesla feasibility study with comparison of incremental and continuous dynamic protocols. Skeletal Radiol 2017; 46:1721-1728. [PMID: 28821929 DOI: 10.1007/s00256-017-2742-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/16/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the feasibility of magnetic resonance cinematography of the fingers (MRCF) with comparison of image quality of different protocols for depicting the finger anatomy during motion. MATERIALS AND METHODS MRCF was performed during a full flexion and extension movement in 14 healthy volunteers using a finger-gating device. Three real-time sequences (frame rates 17-59 images/min) and one proton density (PD) sequence (3 images/min) were acquired during incremental and continuous motion. Analyses were performed independently by three readers. Qualitative image analysis included Likert-scale grading from 0 (useless) to 5 (excellent) and specific visual analog scale (VAS) grading from 0 (insufficient) to 100 (excellent). Signal-to-noise calculation was performed. Overall percentage agreement and mean absolute disagreement were calculated. RESULTS Within the real-time sequences a high frame-rate true fast imaging with steady-state free precession (TRUFI) yielded the best image quality with Likert and overall VAS scores of 3.0 ± 0.2 and 60.4 ± 25.3, respectively. The best sequence regarding image quality was an incremental PD with mean values of 4.8 ± 0.2 and 91.2 ± 9.4, respectively. Overall percentage agreement and mean absolute disagreement were 47.9 and 0.7, respectively. No statistically significant SNR differences were found between continuous and incremental motion for the real-time protocols. CONCLUSION MRCF is feasible with appropriate image quality during continuous motion using a finger-gating device. Almost perfect image quality is achievable with incremental PD imaging, which represents a compromise for MRCF with the drawback of prolonged scanning time.
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Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Werner Adler
- IMBE, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Frank Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany
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Laistler E, Dymerska B, Sieg J, Goluch S, Frass-Kriegl R, Kuehne A, Moser E. In vivo MRI of the human finger at 7 T. Magn Reson Med 2017; 79:588-592. [PMID: 28295563 PMCID: PMC5763334 DOI: 10.1002/mrm.26645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/02/2022]
Abstract
Purpose To demonstrate a dedicated setup for ultrahigh resolution MR imaging of the human finger in vivo. Methods A radiofrequency coil was designed for optimized signal homogeneity and sensitivity in the finger at ultrahigh magnetic field strength (7 T), providing high measurement sensitivity. Imaging sequences (2D turbo‐spin echo (TSE) and 3D magnetization‐prepared rapid acquisition gradient echo (MPRAGE)) were adapted for high spatial resolution and good contrast of different tissues in the finger, while keeping acquisition time below 10 minutes. Data was postprocessed to display finger structures in three dimensions. Results 3D MPRAGE data with isotropic resolution of 200 µm, along with 2D TSE images with in‐plane resolutions of 58 × 78 µm2 and 100 × 97 µm2, allowed clear identification of various anatomical features such as bone and bone marrow, tendons and annular ligaments, cartilage, arteries and veins, nerves, and Pacinian corpuscles. Conclusion Using this dedicated finger coil at 7 T, together with adapted acquisition sequences, it is possible to depict the internal structures of the human finger in vivo within patient‐compatible measurement time. It may serve as a tool for diagnosis and treatment monitoring in pathologies ranging from inflammatory or erosive joint diseases to injuries of tendons and ligaments to nervous or vascular disorders in the finger. Magn Reson Med 79:588–592, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Elmar Laistler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Barbara Dymerska
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jürgen Sieg
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Sigrun Goluch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Roberta Frass-Kriegl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Andre Kuehne
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria.,MRI.TOOLS GmbH, Berlin, Germany
| | - Ewald Moser
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
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Schöffl I, Hugel A, Schöffl V, Rascher W, Jüngert J. Diagnosis of Complex Pulley Ruptures Using Ultrasound in Cadaver Models. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:662-669. [PMID: 28024659 DOI: 10.1016/j.ultrasmedbio.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/06/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Abstract
Pulley ruptures are common in climbing athletes. The purposes of this study were to determine the specific positioning of each pulley with regards to the joint, and to evaluate the ultrasound diagnostics of various pulley rupture combinations. For this, 34 cadaver fingers were analyzed via ultrasound, the results of which were compared to anatomic measurements. Different pulley ruptures were then simulated and evaluated using ultrasound in standardized dynamic forced flexion. Visualization of the A2 and A4 pulleys was achieved 100% of the time, while the A3 pulley was visible in 74% of cases. Similarly, injuries to the A2 and A4 pulleys were readily observable, while A3 pulley injuries were more challenging to identify (sensitivity of 0.2 for singular A3 pulley, 0.5 for A2/A4 pulley and 0.33 for A3/A4 pulley ruptures). Receiver operating characteristic analysis was used to evaluate the optimal tendon-bone distance for pulley rupture diagnosis, a threshold which was determined to be 1.9 mm for A2 pulley ruptures and 1.85 for A4 pulley ruptures. This study was the first to carry out a cadaver ultrasound examination of a wide variety of pulley ruptures. Ultrasound is a highly accurate tool for visualizing the A2 and A4 pulleys in a cadaver model. This method of pathology diagnosis was determined to be suitable for injuries to the A2 and A4 pulleys, but inadequate for A3 pulley injuries.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatrics and Adolescent Medicine, Klinikum Bamberg, Bamberg, Germany; Institute of Anatomy, University Erlangen, Erlangen, Germany.
| | - Arnica Hugel
- Institute of Anatomy, University Erlangen, Erlangen, Germany; IDEWE, Zwijnaarde, Belgium
| | - Volker Schöffl
- Institute of Sports Medicine Bamberg, Klinikum Bamberg, Bamberg, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
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Abstract
PURPOSE OF REVIEW While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries. RECENT FINDINGS With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers. Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.
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Affiliation(s)
- Louis Christopher Grandizio
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA.
| | - Joel Christian Klena
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA
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Abstract
Closed pulley ruptures are rare in the general population but occur more frequently in rock climbers due to biomechanical demands on the hand. Injuries present with pain and swelling over the affected pulley, and patients may feel or hear a pop at the time of injury. Sequential pulley ruptures are required for clinical bowstringing of the flexor tendons. Ultrasound confirms diagnosis of pulley rupture and evaluates degree of displacement of the flexor tendons. Isolated pulley ruptures frequently are treated conservatively with early functional rehabilitation. Sequential pulley ruptures require surgical reconstruction. Most climbers are able to return to their previous activity level.
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Affiliation(s)
- Elizabeth A King
- Department of Orthopaedic Surgery, University of Cincinnati, TriHealth Hospital System, 538 Oak Street, Suite 200, Cincinnati, OH 45219, USA
| | - John R Lien
- Section of Plastic Surgery, Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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Diagnosis, Treatment, and Return to Play for Four Common Sports Injuries of the Hand and Wrist. J Am Acad Orthop Surg 2016; 24:853-862. [PMID: 27792055 DOI: 10.5435/jaaos-d-15-00388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hand and wrist injuries in the high-level athlete are challenging because they may be underestimated by the patient, family, and team, and return to play may be longer than desired. The needs of the player and the team must be balanced with the long-term functional ramifications of the injury. Four common soft-tissue sports injuries are flexor digitorum profundus avulsion, flexor pulley rupture, extensor carpi ulnaris dislocation, and thumb metacarpophalangeal joint ulnar collateral ligament injury. For each of these injuries, the assessment, treatment, and considerations for return to play should be individualized on the basis of the patient, the sport, and the timing of the injury.
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Mifune Y, Inui A, Sakata R, Harada Y, Takase F, Kurosaka M, Kokubu T. High-resolution ultrasound in the diagnosis of trigger finger and evaluation of response to steroid injection. Skeletal Radiol 2016; 45:1661-1667. [PMID: 27717978 DOI: 10.1007/s00256-016-2485-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 05/31/2016] [Accepted: 09/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE No studies have reported the use of ultrasound for the evaluation of trigger finger after steroid injection. We evaluated the clinical features and ultrasound appearance of trigger finger before and after steroid injection under ultrasound guidance. MATERIALS AND METHODS Thirty-eight digits with triggering were included. A single steroid injection into the tendon sheath was administered. Ultrasound findings and clinical symptoms, including pain, triggering, and the Quinnell score, were analyzed before injection and at 1 and 3 weeks after injection. RESULTS Ultrasound indicated that the thickness of the flexor tendons and the thickness of A1 pulleys were significantly greater in the trigger fingers than in controls before steroid injection. Three weeks after injection, these two parameters decreased, and there was no significant difference in the two parameters between the trigger finger and the controls. The visual analogue scales at 1 and 3 weeks after the injection were significantly lower than those before the injection. The Quinnell grading system scores significantly improved at 1 and 3 weeks after injection compared with the scores before injection. Moreover, a tendency was seen for the more clinically severe cases to show more swelling of the tendon and pulley. CONCLUSION In conclusion, ultrasound assessments could reveal that the thickened A1 pulley and flexor tendon significantly improved after steroid injection, which enables us to confirm the therapeutic effects of the steroid injection. Therefore, ultrasound assessments can be a useful adjunct to understand the response to treatment with the steroid injection.
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Affiliation(s)
- Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Sakata
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshifumi Harada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Fumiaki Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Jones G, Johnson MI. A Critical Review of the Incidence and Risk Factors for Finger Injuries in Rock Climbing. Curr Sports Med Rep 2016; 15:400-409. [DOI: 10.1249/jsr.0000000000000304] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Schneeberger M, Schweizer A. Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley-Protection Splint—A Series of 47 Cases. Wilderness Environ Med 2016; 27:211-8. [DOI: 10.1016/j.wem.2015.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 01/20/2023]
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Bouyer M, Forli A, Semere A, Chedal Bornu BJ, Corcella D, Moutet F. Recovery of rock climbing performance after surgical reconstruction of finger pulleys. J Hand Surg Eur Vol 2016; 41:406-12. [PMID: 26763272 DOI: 10.1177/1753193415623914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 11/27/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1-42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Bouyer
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - A Forli
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - A Semere
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - B J Chedal Bornu
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - D Corcella
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - F Moutet
- Service de Chirurgie de la Main et des Brûlés, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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Yang TH, Lin YH, Chuang BI, Chen HC, Lin WJ, Yang DS, Wang SH, Sun YN, Jou IM, Kuo LC, Su FC. Identification of the Position and Thickness of the First Annular Pulley in Sonographic Images. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1075-1083. [PMID: 26831343 DOI: 10.1016/j.ultrasmedbio.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/20/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
The purpose was to identify the A1 pulley's exact location and thickness by comparing measurements from a clinical high-frequency ultrasound scanner system (CHUS), a customized high-frequency ultrasound imaging research system (HURS) and a digital caliper. Ten cadaveric hands were used. We explored the pulley by layers, inserted guide pins and scanned it with the CHUS. After identifying the pulley, we measured each long finger's thickness using the CHUS and excised the pulley to measure its thickness with a digital caliper and the HURS. The thin hypo-echoic layer was revealed to be the synovial fluid space, and the pulley appears hyper-echoic regardless of scan direction. We also defined the pulley's boundaries. Moreover, the CHUS provided a significantly lower measurement of the pulley's thickness than the digital caliper and HURS. Likewise, based on the digital caliper's measurement, the HURS had significantly lower mean absolute and relative errors than the CHUS.
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Affiliation(s)
- Tai-Hua Yang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsun Lin
- Department of Computer Science & Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Bo-I Chuang
- Department of Computer Science & Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Chen Chen
- Department of Radiation Oncology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Wei-Jr Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Dee-Shan Yang
- Department of Orthopedic Surgery, Ton-Yen General Hospital, Hsinchu, Taiwan
| | - Shyh-Hau Wang
- Department of Computer Science & Information Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Nien Sun
- Department of Computer Science & Information Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan.
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Pozzi A, Pivato G, Pegoli L. Hand Injury in Rock Climbing: Literature Review. J Hand Surg Asian Pac Vol 2016; 21:13-7. [DOI: 10.1142/s2424835516400038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the amazing increasing in number of participants, rock climbing has become a popular sport in the last decade. A growing number of participants, with different skill level, inevitably leads to an increased number of injuries related to this practice. The kind of lesions that can be observed in rock-climbers is very specific and often involves the hand. For this reason is very important for any hand surgeon that is exposed to sport injuries to know which and the most common injuries related to this sport and which are the basic principles for the treatment of those. The aim of this article is to review the literature that has been published in the last ten year in this topic. On the NCBI database 22 articles where found that where related to rock climbing lesion affecting the hand or the whole body. Differences where found according to kind of rock climbing activity that was analyzed, alpine climb leads to more serious injuries, often affecting the lower limb, while in sport and recreational rock climbing the upper limb and the hand are definitely the most affected parts. Flexor pulley lesions, followed by fractures and strains are the most common lesions affecting the hand that are related to this practice.
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Affiliation(s)
- A. Pozzi
- Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
| | - G. Pivato
- Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
| | - L. Pegoli
- Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
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Lapegue F, Andre A, Brun C, Bakouche S, Chiavassa H, Sans N, Faruch M. Traumatic flexor tendon injuries. Diagn Interv Imaging 2015; 96:1279-92. [DOI: 10.1016/j.diii.2015.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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Lee JH, Kim HS, Joo SH. Isolated A1 Pulley Rupture of Left Fourth Finger in Kendo Players: Two Case Reports. Ann Rehabil Med 2015; 39:838-43. [PMID: 26605184 PMCID: PMC4654092 DOI: 10.5535/arm.2015.39.5.838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/17/2014] [Indexed: 11/05/2022] Open
Abstract
Annular pulley injury of fingers is usually observed in rock climbers who support their entire body weight with flexed fingers during climbing. But these lesions can also follow trivial trauma, such as lifting heavy objects with the fingertips, or during sports and recreational activities. The A2 and A4 pulleys are most usually involved and reported most frequently. However, traumatic A1 pulley rupture has not been reported yet, to the best of our knowledge. Kendo is a very vigorous martial art with frequent physical contact. Therefore, we reported two cases of repetitive microtraumatic left fourth finger A1 pulley rupture in Kendo players with results from physical examination and imaging studies, such as ultrasonography and magnetic resonance imaging, together with related literature.
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Affiliation(s)
- Jin Hyung Lee
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seung Ho Joo
- Department of Diagnostic Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Bassemir D, Unglaub F, Hahn P, Müller LP, Bruckner T, Spies CK. Sonographical parameters of the finger pulley system in healthy adults. Arch Orthop Trauma Surg 2015; 135:1615-22. [PMID: 26282734 DOI: 10.1007/s00402-015-2304-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION To establish normative values of tendon to bone distances (TBDs) to evaluate the A2 and A4 annular pulley integrity, we hypothesized that these values correlate with gender, athletic exercise, occupation, individual's age and body height. METHODS Ultrasonography of 200 healthy individuals was performed prospectively. TBDs for the A2 and A4 pulley sections were measured for all fingers. Evaluation was performed in resting position and active forced flexion. Examination parameters included gender, age, body height, occupation, athletic exercise level, and hand dominance. Assessment of resting position and active forced flexion was done. RESULTS No clinically relevant differences of TBDs with respect to the aforementioned parameters were observed. But TBDs were significantly greater in active forced flexion than in resting position for all measured pulley sections. Intraobserver reliability was very satisfactory. CONCLUSIONS Establishing normative values will help to detect injured pulleys more precisely and examination should be performed both in resting position and active forced flexion.
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Affiliation(s)
- Dominik Bassemir
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany.,Medical Faculty Mannheim of the Ruprecht-Karls University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Peter Hahn
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
| | - Lars Peter Müller
- Department of Orthopaedics and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Bruckner
- The Department of Medical Biometry and Informatics, Ruprecht-Karls University, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Christian K Spies
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany.
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Abstract
Caring for climbers can be a challenge and requires familiarity with the distinctive mechanisms of common climbing injuries. Injuries such as climber's finger, climber's elbow, extensor hood syndrome, lateral collateral ligamentous injuries from climbing overload, and posttraumatic osteochondritis dissecans, among others, cannot be diagnosed if the practitioner does not have a specialized knowledge of the sport and the mechanisms of trauma and overuse that can occur. Understanding these injuries will increase the provider's breadth of knowledge and will bridge trust with patients who climb.
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Affiliation(s)
- Charles Peterson
- 1Mayo Clinic College of Medicine, Rochester, MN; 2Arizona Sports Medicine Center, Mesa, AZ 85204; 3Wake Forest University Baptist Medical Center, Winston-Salem, NC
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Bayer T, Adler W, Schweizer A, Schöffl I, Uder M, Janka R. Evaluation of finger A3 pulley rupture in the crimp grip position-a magnetic resonance imaging cadaver study. Skeletal Radiol 2015; 44:1279-85. [PMID: 25930946 DOI: 10.1007/s00256-015-2160-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture. MATERIALS AND METHODS MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured. RESULTS Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm. CONCLUSION Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture.
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Affiliation(s)
- Thomas Bayer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
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Chang CY, Torriani M, Huang AJ. Rock Climbing Injuries: Acute and Chronic Repetitive Trauma. Curr Probl Diagn Radiol 2015; 45:205-14. [PMID: 26360057 DOI: 10.1067/j.cpradiol.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 01/03/2023]
Abstract
Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA.
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ambrose J Huang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
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