Ultrasound signs of injuries and diseases of the wrist and joints of the hand

The Tenosynovites. One of the most frequent pathologies of this localization. The most common cause of development of tenosynovitis is rheumatoid arthritis. With the development of tenosynovitis, effusion occurs in the synovial vagina of the tendons. The synovial membrane thickens, the degree of its vascularization increases. With chronic tenosynovitis, the tendon itself is involved in the process, which can contribute to its rupture. With tenosynovitis of small tendons of the hand, the detection of effusion is difficult. Indirect signs of its presence is an increase in echogenicity of the bone phalanx. For clarification, a comparison with a symmetrical phalanx is recommended.

Tendon ruptures. Tears of the tendon of the wrist joint and the joints of the hand are relatively rare. Tensions are predisposed to chronic changes in tendons, rheumatoid arthritis, gouty arthritis, systemic diseases, diabetes mellitus, etc. Detachment of the extensor tendon of the finger from the attachment site at the base of the nail phalanx is the most frequent of the subcutaneous ruptures of the tendons. It occurs with a sharp bending of the finger at a time when the tendon is actively reduced. Such detachments are observed when playing basketball, pianists, surgeons. The detachment of the tendon can be accompanied by the detachment of a triangular fragment from the base of the phalanx. In this type of injury, the finger acquires a characteristic hammer-shaped shape.

At full rupture, an empty synovial vagina with effusion is defined. With partial ruptures of the tendon at the site of the rupture, its structure is disrupted, and an effusion appears in the synovial vagina. With chronic tendinitis in the area of attachment of tendons, hyperechoic inclusions can form. The tendon is usually thickened, its echogenicity is reduced.

Tenosinovit de Kervena. Refers to idiopathic tenosynovitis. In this disease, the first channel of the reinforcing fibrous strand is involved in the process, in which the tendon of the short extensor of the fingers passes and the long tendon that leads the finger in the region of the styloid process of the radius on the back surface of the wrist joint.

More often the disease affects women than men, in a ratio of 6 to 1. The disease occurs between the ages of 30 and 50 years.

Clinically manifested in the form of pain syndrome from the side of the radial bone, which increases with the movement of the fingers. Palpation is marked swelling of this zone.

Echographically revealed fluid in the thickened synovial vagina of the tendons. The tendon of the short extensor of the fingers or the long tendon of the outgoing finger, as a rule, is not thickened.

Cysts of ganglia (hygromes). One of the frequent pathologies of the tendons of the hand. A characteristic ultrasound sign of the ganglion is the direct connection with the tendon. Ganglions are oval or round in shape, encapsulated. The contents can have a different consistency depending on the prescription of the disease.

Lacerations of the lateral ligaments. The most common is a dislocation of one finger in the metacarpophalangeal articulation. Sharp and excessive removal of 1 finger can lead to rupture of the medial lateral metacarpophalangeal ligament. As a result, a subluxation of the phalanx occurs.

Dupuytren's contracture. It is an idiopathic benign proliferative process, leading to the growth of fibrous tissue in the palmar aponeurosis. It occurs more often in men older than 30 years. As a rule, tissues of 3, 4, 5 fingers are affected. In most cases, the manifestations affect both brushes. Fibrous tissue appears in the fibrous-fatty layer between the skin and deep palmar structures, leading to the appearance of collagen nodules and strands. The palmar aponeurosis becomes scarred, compacted, wrinkled; the subcutaneous-fatty tissue gradually disappears, and the skin, funnel-like drawn into separate areas, fuses with the altered thickened aponeurosis. As a result of the transformation of fine aponeurotic fibers into dense strands, the fingers are bent and shortened. In this case the tendons of the flexor of the fingers are not subjected to pathological changes. The process develops gradually and is characterized by a wave-like chronic course. In later stages, the disease is easily diagnosed clinically, whereas in the early stages these nodules can only be recognized by ultrasound. Echographically, the changes look like hypoechoic formations lying subcutaneously, in the palmar fascia or aponeurosis.

Carpal tunnel syndrome. This is the most common pathology of compression mediastinal nerve neuropathy. Often there is a typists, cloakroom attendants, programmers, musicians, auto mechanics. Clinically manifested by pain and paresthesias in the wrist and forearm, amplified at night and with brush movements, sensory and motor impairments. Ultrasound examination plays an important role in establishing the diagnosis, clarifying the severity of the disease and monitoring treatment. The main ultrasound manifestations of carpal syndrome include: thickening of the nerve proximal to compression, flattening of the nerve inside the tunnel, bulging forward of the flexor flexor retainer, decreased nerve mobility within the tunnel. Measurements of the medial nerve are carried out with transverse scanning according to the formula of the ellipse area: the product of two mutually perpendicular diameters divided by four times the number of 7Г. Studies have shown that the average area of the medial nerve in men is 9-12 mm ² and in women 6-8 mm ². If the ratio of width to anterior-posterior nerve size exceeds 3 to 1, then carpal syndrome is diagnosed.

With the development of this syndrome, the area of the medial nerve also increases. And the increase in the transverse diameter of the nerve is directly proportional to the degree of severity of the syndrome. With an area larger than 15 mm ², surgical correction is required. Bending the front of the flexor flexor retainer by more than 2.5 mm indicates the development of carpal syndrome. It was found that when the fifth finger moves normally, the medial nerve is displaced an average of 1.75 ± 0.49 mm, while in carpal syndrome it is only 0.37 ± 0.34 mm. Using a combination of these characteristics together with clinical data, it is easy enough to diagnose the initial signs of the disease.

Foreign bodies. The most frequent localization of foreign bodies is hands. Foreign bodies can be of different nature: sewing needles, pieces of metal, fish bones, wood chips (splinters), thorns of thorny plants. Echographically, they look like a hyperechoic fragment in the thickness of soft tissues. Depending on the composition behind the body, there may be a distal reverberation effect (metal, glass) or shadow (wood).