Learning objectives
To review the normal anatomy and sonographic appearences of the flexor and extensor tendons of the fingers.
To discuss the range of pathologies that can affect the flexor and extensor tendons and their appearance on ultrasound.
To review the various intervention techniques under ultrasound guidance for treating some of these conditions.
Background
Ultrasound is increasingly utilized for diagnostic purpose and therapeutic injections of the extensor and flexor tendons of the fingers.
It has the advantage of obtaining high quality images at a low cost,
the ability to perform dynamic maneuvers and to guide interventional procedures. A detailed knowledge of the anatomy is essential to accurately diagnose the pathology and guide treatment.
This educational poster will review the anatomy,
normal and abnormal sonographic appearences and discuss how ultrasound interventions can reduce the need for surgical intervention.
Imaging findings OR Procedure Details
Anatomy of the Flexor tendons:
The flexor tendons of the index,
middle,
ring and small fingers consist of the flexor digitorum superficialis (FDS) and the flexor digitorum profundus (FDP) and are responsible for flexing the joints of the hand and fingers.
The FDP is the only flexor of the distal interphalangeal joint (DIPJ).
The FDS tendons lie superficial (volar) to the FDP.
At the mid diaphysis of the proximal phalanx,
the FDS tendon splits in two and one passes medial to the FDP and the...
Conclusion
Ultrasound is an excellent tool for the investigation of disorders of the flexor and extensor tendons of the fingers.
A detailed knowledge and understanding of the normal anatomy and range of common pathologies is essential for accurate diagnosis and guiding appropriate management.
Ultrasound guided intervention can also be useful in some cases such as the management of tenosynovitis,
pulley fibromas and pulley ganglia.
References
References:
1.
Doyle JR.
Anatomy of the finger flexor tendon sheath and pulley system.
J Hand Surg Am 1988; 13:473–484 .
2.
Hauger O,
Chung CB,
Lektrakul N,
et al.
Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging,
CT,
and US with and without contrast material distention of the tendon sheath.
Radiology 2000; 217:201–212
3.
Leddy JP,
Packer JW.
Avulsion of the profundus tendon insertion in athletes.
J Hand Surg Am 1977; 2:66–69.
4.
Trumble TE,
Vedder NE,...