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Dynamic Ultrasound With Anatomic Correlation of the Wrist and Hand

February 19, 2016

Contributors: Giacomo Cappelleti, MD; Orry Erez, MD; Elan Golan, MD; David M Edelstein, MD; Jeffrey Orr, MD; Jeffrey Orr, MD

The popularity of ultrasonography, which is a cheap and readily available diagnostic tool, as a method of direct visualization that facilitates the diagnosis and management of many types of pathology recently has increased. With regard to the practice of orthopaedics, ultrasonography has been used across multiple subspecialties, from identifying pediatric hip effusion to dynamic testing and direct visualization of suspected rotator cuff pathology. As an increasing number of clinicians begin to incorporate ultrasonography into their practice, a basic understanding of its use is necessary. This video reviews how ultrasonography can be effectively used in the management of common orthopaedic hand pathology. The video reviews common applications of ultrasonography for direct visualization, such as identifying the first dorsal compartment in patients with De Quervain tenosynovitis and localizing the A1 pulley for trigger finger injections. The video also reviews common uses for dynamic stress testing in patients with upper extremity pathology, including ulnar collateral ligament stress testing for gamekeepers thumb and ultrasonographic-guided assessment of distal radioulnar joint instability. Several common provocative tests for scapholunate ligament compromise, such as the Watson and scapholunate clenched fist tests, are reviewed with simultaneous direct visualization under ultrasonographic guidance.