Ultrasonographic evaluation of tendon injuries in hand trauma: a crucial tool for emergency care

BACKGROUND: Hand injuries, particularly tendon injuries, are a common reason for emergency department visits and may significantly impact daily functioning. Traditional diagnostic approaches may fail to detect partial tendon injuries, highlighting the need for alternative imaging techniques. Ultrasonography (USG) has emerged as a rapid, non-invasive, and effective diagnostic tool for tendon injuries, particularly in emergency settings where magnetic resonance imaging (MRI) may not be readily available. This study evaluates the diagnostic effectiveness of ultrasonography in assessing tendon injuries among patients presenting with hand trauma in the emergency department (ED). Ultrasonography findings were compared with clinical evaluations to determine its role in diagnosing tendon injuries and guiding surgical management. This prospective observational study was conducted in the ED of a single tertiary-care hospital over a one-year period and included adult patients presenting with hand injuries. METHODS: Patients who met the inclusion criteria underwent both clinical evaluation and ultrasonographic examination. A total of 68 patients were included in the study. All assessments were performed by an experienced emergency medicine physician using a Philips Affinity S70 ultrasonography system (Philips Healthcare, Bothell, WA, USA). Collected data included patient demographics, injury characteristics, ultrasonographic findings, and the need for surgical intervention. Statistical analyses were performed using the chi-square test and binary logistic regression to compare the diagnostic performance of the two methods. RESULTS: Ultrasonography demonstrated a sensitivity of 82.6% (95% confidence interval CI: 0.69-0.91), specificity of 90.9% (95% CI: 0.70-0.98), and an overall accuracy of 85.3% (95% CI: 0.75-0.92) in predicting the need for tendon repair. Clinical evaluation showed slightly lower diagnostic performance, with a sensitivity of 80.4% (95% CI: 0.67-0.89) and an accuracy of 80.9% (95% CI: 0.70-0.89). CONCLUSION: Regression analysis indicated that ultrasonography increased the likelihood of accurately diagnosing tendon injuries by 21.8 times compared to clinical assessment. Together, clinical evaluation and ultrasonography predicted 61% of all cases requiring tendon repair.