The Predictive Value of Ultrasound Scanning in Certain Hand and Wrist Conditions

Fast and accurate diagnosis of conditions of the hand and wrist is essential in guiding management. We aimed to analyse the predictive value of ultrasound in identifying different pathologies in the hand and wrist by correlating pre-operative ultrasound findings with per-operative surgical findings.

We retrospectively reviewed the case notes of all patients under the care of the senior author on whom a hand/wrist ultrasound had been performed between January 2007-May 2013. Of these only patients who proceeded to surgery were included as this was the correlating endpoint. Positive and negative predictive values (PPV/NPV) and sensitivity and specificity were calculated for ultrasound in identifying (i) post-repair complete tendon ruptures (versus intact repairs with scar adherence), (ii) ganglionic cysts, (iii) soft tissue masses and (iv) nerve injuries.

Of 70 patients who underwent ultrasound, 36 proceeded to surgery. Fifteen patients were post traumatic and the remaining 21 were elective presentations. The median age was 38 (range 14-87) with a 1.25:1 male to female ratio. All results had a 95% confidence interval. Ultrasound had a 100% PPV for identifying post-repair complete tendon ruptures and for ganglionic cysts (sensitivities 75% and 87% respectively). Of our 6 soft tissue masses ultrasound also showed a 100% PPV. For the two nerve injury patients, PPV was 100%.

Our study shows that ultrasound is diagnostic for post-repair tendon ruptures and ganglionic cysts, and shows promising results for benign soft tissue masses and nerve injuries. We propose the use of ultrasound as an extension to physical examination in a dynamic clinic setting.