Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations

Bobby Dezfuli, Mihra Taljanovic, David M. Melville, Elizabeth A Krupinski, Joseph E Sheppard

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Lacerations to the extensor mechanism are usually diagnosed clinically. Ultrasound (US) has been a growing diagnostic tool for tendon injuries since the 1990s. To date, there has been no publication establishing the accuracy and reliability of US in the evaluation of extensor mechanism lacerations in the hand. The purpose of this study is to determine the accuracy of US to detect extensor tendon injuries in the hand. Methods Sixteen fingers and 4 thumbs in 4 fresh-frozen and thawed cadaveric hands were used. Sixty-eight 0.5-cm transverse skin lacerations were created. Twenty-seven extensor tendons were sharply transected. The remaining skin lacerations were used as sham dissection controls. One US technologist and one fellowship-trained musculoskeletal radiologist performed real-time dynamic US studies in and out of water bath. A second fellowship trained musculoskeletal radiologist subsequently reviewed the static US images. Dynamic and static US interpretation accuracy was assessed using dissection as truth. Results All 27 extensor tendon lacerations and controls were identified correctly with dynamic imaging as either injury models that had a transected extensor tendon or sham controls with intact extensor tendons (sensitivity = 100%, specificity = 100%, positive predictive value = 1.0; all significantly greater than chance). Static imaging had a sensitivity of 85%, specificity of 89%, and accuracy of 88% (all significantly greater than chance). The results of the dynamic real time versus static US imaging were clearly different but did not reach statistical significance. Conclusions Diagnostic US is a very accurate noninvasive study that can identify extensor mechanism injuries. Clinically suspected cases of acute extensor tendon injury scanned by high-frequency US can aid and/or confirm the diagnosis, with dynamic imaging providing added value compared to static. Ultrasonography, to aid in the diagnosis of extensor mechanism lacerations, can be successfully used in a reliable and accurate manner.

Original languageEnglish (US)
Pages (from-to)187-192
Number of pages6
JournalAnnals of Plastic Surgery
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Lacerations
Tendons
Ultrasonography
Tendon Injuries
Hand
Dissection
Sensitivity and Specificity
Skin
Thumb
Wounds and Injuries
Baths
Fingers
Publications
Water

Keywords

  • extensor mechanism
  • extensor tendons
  • lacerations
  • ultrasonography

ASJC Scopus subject areas

  • Surgery

Cite this

Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations. / Dezfuli, Bobby; Taljanovic, Mihra; Melville, David M.; Krupinski, Elizabeth A; Sheppard, Joseph E.

In: Annals of Plastic Surgery, Vol. 76, No. 2, 01.02.2016, p. 187-192.

Research output: Contribution to journalArticle

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abstract = "Background Lacerations to the extensor mechanism are usually diagnosed clinically. Ultrasound (US) has been a growing diagnostic tool for tendon injuries since the 1990s. To date, there has been no publication establishing the accuracy and reliability of US in the evaluation of extensor mechanism lacerations in the hand. The purpose of this study is to determine the accuracy of US to detect extensor tendon injuries in the hand. Methods Sixteen fingers and 4 thumbs in 4 fresh-frozen and thawed cadaveric hands were used. Sixty-eight 0.5-cm transverse skin lacerations were created. Twenty-seven extensor tendons were sharply transected. The remaining skin lacerations were used as sham dissection controls. One US technologist and one fellowship-trained musculoskeletal radiologist performed real-time dynamic US studies in and out of water bath. A second fellowship trained musculoskeletal radiologist subsequently reviewed the static US images. Dynamic and static US interpretation accuracy was assessed using dissection as truth. Results All 27 extensor tendon lacerations and controls were identified correctly with dynamic imaging as either injury models that had a transected extensor tendon or sham controls with intact extensor tendons (sensitivity = 100{\%}, specificity = 100{\%}, positive predictive value = 1.0; all significantly greater than chance). Static imaging had a sensitivity of 85{\%}, specificity of 89{\%}, and accuracy of 88{\%} (all significantly greater than chance). The results of the dynamic real time versus static US imaging were clearly different but did not reach statistical significance. Conclusions Diagnostic US is a very accurate noninvasive study that can identify extensor mechanism injuries. Clinically suspected cases of acute extensor tendon injury scanned by high-frequency US can aid and/or confirm the diagnosis, with dynamic imaging providing added value compared to static. Ultrasonography, to aid in the diagnosis of extensor mechanism lacerations, can be successfully used in a reliable and accurate manner.",
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