Next imaging study. CT Hand CT has limited use for the diagnosis of soft-tissue injuries of the fingers. MRI Hand MRI is ideal for evaluating tendon injuries and helping with surgical planning [58]. MRI may be used to assess capsule and collateral ligament injuries of the proximal interphalangeal and metacarpophalangeal joints [68]. MRI allows for the assessment of pulley system lesions [66,67]. MRI can accurately depict the pulley system, particularly the A2 and A4 pulleys, with lower sensitivity for A3 and A5 pulleys [70]. Hauger et al [70] reported direct identification of A2 and A4 pulleys in 12 of 12 cases (100%) and direct diagnosis of an abnormal A2 pulley in 100% and A4 pulley in 91% of 33 cases. For volar plate injuries, MRI may be used to diagnose tears that do not involve the underlying bone [71]. This is important because untreated lesions can result in contractures or joint laxity [72]. MRI is especially useful for detection of ulnar collateral ligament and radial collateral ligament injuries. Pfirrmann et al [74] reported a sensitivity of 67% and a specificity of 91% for collateral ligament injuries of the lesser metacarpophalangeal joints. With MR arthrography, sensitivity and specificity increased to 75% and 98%, respectively [74]. US Hand Dynamic US allows direct visualization of subluxation/dislocation of the extensor tendon while the patient flexes the metacarpophalangeal joint [16,75]. US helps evaluate injured flexor tendons and, in cases of completely lacerated tendons, helps identify the location of the proximal tendon stump [76]. Acute Hand and Wrist Trauma US allows for assessment of pulley system injuries [66,67], particularly the A2 and A4 pulleys, with lower sensitivity for A3 and A5 pulleys [70]. Bone Scan Hand Bone scan is not indicated in this clinical setting. Variant 7: Suspect penetrating trauma with a foreign body in the soft tissues in the hand or wrist. Initial radiographs are negative. Next imaging study.
Acute Hand and Wrist Trauma. Next imaging study. CT Hand CT has limited use for the diagnosis of soft-tissue injuries of the fingers. MRI Hand MRI is ideal for evaluating tendon injuries and helping with surgical planning [58]. MRI may be used to assess capsule and collateral ligament injuries of the proximal interphalangeal and metacarpophalangeal joints [68]. MRI allows for the assessment of pulley system lesions [66,67]. MRI can accurately depict the pulley system, particularly the A2 and A4 pulleys, with lower sensitivity for A3 and A5 pulleys [70]. Hauger et al [70] reported direct identification of A2 and A4 pulleys in 12 of 12 cases (100%) and direct diagnosis of an abnormal A2 pulley in 100% and A4 pulley in 91% of 33 cases. For volar plate injuries, MRI may be used to diagnose tears that do not involve the underlying bone [71]. This is important because untreated lesions can result in contractures or joint laxity [72]. MRI is especially useful for detection of ulnar collateral ligament and radial collateral ligament injuries. Pfirrmann et al [74] reported a sensitivity of 67% and a specificity of 91% for collateral ligament injuries of the lesser metacarpophalangeal joints. With MR arthrography, sensitivity and specificity increased to 75% and 98%, respectively [74]. US Hand Dynamic US allows direct visualization of subluxation/dislocation of the extensor tendon while the patient flexes the metacarpophalangeal joint [16,75]. US helps evaluate injured flexor tendons and, in cases of completely lacerated tendons, helps identify the location of the proximal tendon stump [76]. Acute Hand and Wrist Trauma US allows for assessment of pulley system injuries [66,67], particularly the A2 and A4 pulleys, with lower sensitivity for A3 and A5 pulleys [70]. Bone Scan Hand Bone scan is not indicated in this clinical setting. Variant 7: Suspect penetrating trauma with a foreign body in the soft tissues in the hand or wrist. Initial radiographs are negative. Next imaging study.