Original Communications
Ultrasound evaluation of flexor tendon lacerations*,**,*,**

https://doi.org/10.1053/jhsu.2000.jhsu25a0236Get rights and content

Abstract

Thirteen injured digits in 10 patients (10 hands) with 20 potentially injured flexor tendons were preoperatively evaluated using real-time ultrasonography. The time interval between injury and ultrasonographic evaluation averaged 22 days. If a complete tendon laceration was found, the location of the proximal tendon stump was determined. Surgery was performed an average of 4 days after the ultrasonographic evaluation to determine the accuracy of the ultrasound study. Ultrasonography accurately identified the status of the flexor tendon in 11 of 13 digits and in 18 of 20 flexor tendons (12 intact, 2 partial lacerations, and 6 complete tendon lacerations). With complete tendon lacerations the location of the proximal tendon stump was accurately identified in 5 of 6 digits. There were 2 false ultrasound findings, including incorrectly identifying a 75% laceration in an intact index flexor and a complete tendon laceration in a 75% lacerated index finger flexor. Ultrasonography can help to evaluate the preoperative status of injured flexor tendons and, in cases of completely lacerated tendons, can help identify the location of the proximal tendon stump. (J Hand Surg 2000; 25A:236–241. Copyright © 2000 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

Thirteen injured digits in 10 hands in 10 patients (8 males and 2 females) were preoperatively evaluated using real-time ultrasonography (Table 1).

. Patient Demographics

Patient No.Age (y)Injured Hand DigitMechanism of InjuryTime to Scan (d)Time to Surgery (d)
117RThumbGunshot110
225RIndex, long, ringKnife106
329RThumbKnife43
448LThumbSaw blade25
542LIndex (palm)Knife210
646RLong, ring (palm)Knife72
723RThumbCan1686
846LIndexBand saw03
922LIndexKnife41
1036LIndexBarbecue grill124
The right and left hands were

Results

Ultrasonography was accurate in determining the status of the flexor tendon in 11 of 13 digits and in 18 of 20 potentially injured flexor tendons (12 intact, 2 partial tendon lacerations, and 6 complete tendon lacerations; Table 2).

. Results of Surgical Findings and Ultrasound Studies

Patient No.Surgical FindingsUltrasound Accurate?Identify Proximal End of Tendon?  Other Injured Structures
1Intact FPLYes × 1Metacarpal fracture
Intact index FDS, FDP
Intact ring FDS, FDP
Intact long FDS
2Cut long FDPYes ×

Discussion

There are several potential uses of ultrasonography in examining the hand, including evaluating flexor and extensor tendon lacerations and avulsion injuries. Ultrasound can also evaluate the status of repaired tendons, ligament injuries, masses, and fluid collections (eg, ganglions, abscesses) and detect foreign bodies.1, 2 To date, the experience in evaluating flexor tendon injuries with ultrasonography is limited.

Corduff et al3 used ultrasonography to evaluate repaired flexor tendons. These

References (11)

There are more references available in the full text version of this article.

Cited by (82)

  • Comparative Sensitivity and Specificity of Static and Dynamic High-Resolution Ultrasound in Diagnosis of Small Gaps in Repaired Flexor Tendons: A Cadaveric Study

    2021, Journal of Hand Surgery
    Citation Excerpt :

    Aside from improved resolution, it offers portability, readiness, noninvasiveness, affordability, and the ability to evaluate structures dynamically.22 It has also been used to diagnose hand conditions, such as rupture after flexor tendon repair.7 Dynamic evaluation can help distinguish rupture from adhesions, both causes of decreased active motion after repair,16 but may be limited by pain, concern of stressing recently repaired tendons, and technical difficulty in small fingers, or those with fixed contractures.

  • Musculoskeletal Ultrasound in the Emergency Department: Is There a Role?

    2021, Seminars in Roentgenology
    Citation Excerpt :

    Emergent or urgent assessment of tendon rupture in the finger can be performed with dynamic US, which has been shown to have greater sensitivity and specificity than physical exam, while being quicker to perform than MRI.61 US can identify the proximal stump of a completely ruptured tendon, information that is important for surgical planning.68 Annular pulley disruption can also be diagnosed with dynamic US.69

  • ACR Appropriateness Criteria <sup>®</sup> Acute Hand and Wrist Trauma

    2019, Journal of the American College of Radiology
View all citing articles on Scopus
*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

**

Reprint requests: Donald H. Lee, MD, Division of Orthopedic Surgery, 505 MEB, 1813 Sixth Ave S, University of Alabama at Birmingham, Birmingham, AL 35294.

*

0363-5023/00/25A02-0004$3.00/0

**

J Hand Surg 2000; 25A:236–241

View full text