Color Doppler ultrasonographic findings show tendon sheath inflammation in mechanic's hands

Two male patients with mechanics hands and concomitant interstitial lung disease, Raynaud's phenomenon, dermatomyositis-like rash, and arthritis were evaluated with gray-scale ultrasonography (US) and color Doppler US of the hands using a high-resolution hockey stick configuration 10-MHz transducer (ATL3000). Color Doppler US and gray scale US images of the flexor tendons were obtained at the level of the metacarpophalangeal joint. Initial gray-scale US demonstrated subcutaneous tissue and tendon thickening and synovial sheath effusion; color Doppler US demonstrated hyperemia of the subcutaneous tissues and tendons. Flexor tendon dysfunction on physical examination was proportional to hyperemia and thickening of structures shown by US. Follow-up examination, at a time when patients were improved, showed decreased blood flow in tendon sheaths and subcutaneous tissues and resolution of synovial sheath effusion; one patient, however, demonstrated accumulation within the sheath. Relative improvement in functional status mirrored the changes in the US. The color Doppler US finding of increased blood flow in the soft tissues of these two patients with mechanic's hands represents a physiologic anatomic abnormality amenable to treatment and provides prognostic information for these patients. Mechanic's hands and tenosynovitis occur in patients like these without muscle weakness.