Emergency Department Point-of-Care Ultrasound for Suspected Tendon Ruptures: Use and Implementation

This is the authors' abstract. We don't add key points for this paper.

Tendon injuries are a frequent cause of presentation to the emergency department (ED), but their diagnosis can be challenging upon initial examination. Point-of-care ultrasound (POCUS) has emerged as a powerful, non-invasive diagnostic tool that can be rapidly deployed at the bedside. This review highlights the current evidence on the use of POCUS for diagnosing common tendon ruptures in the ED, focusing on diagnostic accuracy, dynamic scanning techniques, and practical implementation considerations. Recent meta-analyses and prospective studies demonstrate high diagnostic accuracy of point-of-care ultrasound (POCUS) for identifying complete ruptures of the Achilles, quadriceps, patellar, distal biceps, rotator cuff, and digital flexor and extensor tendons compared with magnetic resonance imaging (MRI). POCUS is an accurate imaging tool that can be used to evaluate tendon ruptures presented in the ED to expedite diagnosis, facilitate appropriate consultation, and, in many cases, replace the need for more advanced and expensive imaging alternatives such as MRI. In the dynamic environment of the emergency department (ED), the timely and accurate diagnosis of tendon ruptures is paramount to effective patient management. Point-of-care ultrasound (POCUS) emerges as a transformative tool in this regard, fundamentally reshaping the initial approach to these injuries. Our opinion is that POCUS should be integrated as a primary diagnostic modality for suspected tendon ruptures, not merely as an adjunct, given its proven diagnostic accuracy and practical advantages. The treatment pathway for tendon ruptures, whether surgical or conservative, hinges upon a swift and precise diagnosis. The use of POCUS facilitates this therapeutic goal by offering immediate, bedside visualization of tendon integrity, including dynamic assessment during movement. This capability allows clinicians to rapidly confirm full-thickness tears, differentiate them from partial injuries, and assess the degree of retraction. Such real-time information is crucial for expediting appropriate orthopedic consultation and guiding initial management decisions, thereby preventing delays that can complicate outcomes. By providing clarity early in the patient's ED course, POCUS enables a more informed and tailored treatment strategy from the outset. Furthermore, POCUS offers a cost-effective and accessible alternative to more advanced imaging modalities like MRI, which may not be readily available and can introduce significant delays. Its ability to reduce reliance on these resources streamlines the diagnostic process, allowing for quicker progression to definitive treatment. While operator experience is a factor, the benefits of POCUS in accelerating diagnosis and optimizing the treatment trajectory for tendon ruptures in the ED are undeniable, making it an indispensable component of modern emergency care.