Diagnosing Hand and Wrist Tendon Injuries in Patients with Questionable Physical Findings: Let POCUS Show Its True Mettle

Background: The hand and wrist are functionally the most important parts of the body that are also very prone to traumatic injuries. Clinical examinations have inherent shortcomings in accurate diagnosis of tendon injuries. This makes diagnostic surgical exploration mandatory in the setting of questionable clinical findings. It is valuable to have an adjunctive diagnostic modality on hand to complement clinical findings and obviate the need for unnecessary surgery. Objectives: The primary purpose of this article was to investigate the overall accuracy of point of care ultrasound performed by emergency physicians for the diagnosis of tendon lacerations. Methods: One hundred and twelve patients with penetrating trauma to the volar aspect of hand or wrist and questionable clinical findings took part in this prospective study. All patients were candidates for exploratory surgery and underwent diagnostic ultrasonography to evaluate tendon rupture before surgery. Ultrasound results were compared with surgical evaluation results as the standard test. Results: This research found a specificity of 99.4% and sensitivity of 100% for POCUS in the diagnosis of tendon rupture in traumas to the volar aspect of the hand and wrist. Conclusions: The POCUS can be a reliable modality to evaluate tendon injuries in patients with suspicious clinical findings. Using this modality may obviate the need for a mere diagnostic surgical exploration.