Imaging Studies

Plain-film radiographs of the hand or wrist should be obtained when a patient presents with a soft tissue injury suggestive of fracture or an occult foreign body. Of particular concern are lacerations from glass. Radiography is indicated in dislocation of a DIP joint to rule out fracture. In dislocation of an MCP joint, the posterior-anterior view shows marked widening of the joint. Sesamoid bones seen inside the joint space on radiographs are diagnostic of complex MCP joint dislocation.

MRI has been shown to be highly sensitive in detecting ruptured tendons. However, it does not have a role in emergent management of hand wounds.

Ultrasonography has a growing role in locating foreign bodies and in evaluating soft tissues (see the image below). It can be used to detect ruptured tendons and ulnar collateral ligament injuries to the thumb. Also, the dynamic function of tendons can be assessed noninvasively with ultrasonography. Ultrasound evaluation in the long axis with use of dynamic imaging allows visualization of the ulnar collateral ligament and adductor pollicis aponeurosis. Ultrasound has also been found to be accurate in diagnosing Stener lesions.^{[11, 12]}

One prospective study found that high-resolution ultrasound (5-13 Mhz) is often superior to clinical diagnosis of many disorders, including ganglion cysts, tendinopathies, and retained foreign bodies.^[13]However, it is less accurate with diagnosis of solid lesions.^{[13, 14]}

This image shows an ultrasound of the flexor tendon of a finger with the structures labeled. It was performed using a water bath with the water as the conduction agent. (Image courtesy of Dr. Christopher Moore and Dr. Michael Osborne.)

View Media Gallery

Treatment & Management

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Media Gallery

Metacarpophalangeal joints of the digits
Volar tendons at the wrist. These can be used as landmarks for injections.
Sagittal section of extensor compartments
Superficial volar sensation of the hand
Superficial dorsal sensation of the hand
Boutonnière deformity due to closed central tendon rupture
Boutonnière deformity
Mallet finger due to loss of central extensor tendon to the distal phalanx
This image shows an ultrasound of the flexor tendon of a finger with the structures labeled. It was performed using a water bath with the water as the conduction agent. (Image courtesy of Dr. Christopher Moore and Dr. Michael Osborne.)

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Author

Andrea B Lese, MD Assistant Professor, Department of Orthopedics, West Virginia University School of Medicine

Andrea B Lese, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth R Chuang, MD Attending Physician, Emergency Department, Long Beach Memorial Medical Center and Miller Children's Hospital

Disclosure: Nothing to disclose.

Wyatt Decker, MD Vice President and Chief Executive Officer, Mayo Clinic Campus, Arizona

Wyatt Decker, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Kahill Glenn, MD, to the development and writing of this article.

Sections Soft Tissue Injuries of the Hand
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Media Gallery
References

Soft Tissue Injuries of the Hand Workup

Imaging Studies

References

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