الفهرس 
GROSS ANATOMY OF SMALL JOINTS AND TENDONS OF THE HANDOnly 14 pages are availabe for public view
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Abstract
US is useful at all stages of assessment and management of inflammatory joint disease and can facilitate early diagnosis and quantification of activity, and is a valuable tool in the monitoring of response to therapy.
High resolution US qualifies as one of the most important tools in the detection and quantification of rheumatic pathology in the hand.
In case of local swelling, US is the first tool for differential diagnosis. The advantages of being a safe, widely available and non invasive imaging technique makes it particularly suitable for being used at the bedside in clinical practice.
In routine rheumatological practice, ultrasound of the small joints of the hands accurately detects occult synovial disease and allows classification of the extent and activity of synovitis .
US can detect inflammation before the clinical examination discerns such processes, as it can detect synovial thickening or increased signal on power Doppler. US detects minimal effusion missed by clinical examination. The diagnosis and management of inflammatory arthropathies can be influenced by US findings such as identification of the existence, type, and severity of synovial disease.
Ultrasonography is an established imaging tool in the diagnosis and assessment of inflammatory and non-inflammatory joint diseases and plays an important role in monitoring therapy. US can visualize several soft-tissue structures and is able to detect a variety of pathologic changes ,such as alterations of cartilages, bone surfaces, and synovial tissue changes in osteoarthritis or rheumatoid arthritis. US is particularly useful in the early detection of inflammatory signs in patients witharthritis by using Doppler and power-Doppler ultrasound.
Ultrasound together with laboratory investigations may also be used to guide treatment, as in Rheumatoid arthritis. It is also sometimes useful in evaluating the condition’s response to treatment.
MRI and sonography have opened new horizons in the detection of early joint damage. Ultrasound has unparalleled spatial resolution when applied to small joints, though its value depends on the experience of the user. MRI results are far less dependent on operator experience
However, sonography is a quick and inexpensive way to detect synovitis, whereas MRI allows a more global approach to the small synovial joints of the appendicular skeleton,so MRI and ultrasound has a complementary tools rather than being rivals for the diagnosis and follow-up of small joint disease.
The hand tendons may be affected by a large variety of diseases, such as traumatic and overuse conditions, as well as inflammatory, metabolic, and infectious disorders. When tendon pathology is present, sonography can be used to find the cause of the disorder. The examiner can ask the patient where he or she hurts and perform provocative maneuvers that reproduce the patient’s symptoms while
imaging in real‐time. Color & Power Doppler Sonography can also be used when blood flow information is desired.
Dynamic imaging is mandatory to reveal an absence of the normal sliding motion during contraction and relaxation of the involved muscle.The tendon should be examined carefully from their myotendinous junctions to their bony insertions during both passive and active motion .
Because of its comparative and dynamic capabilities and it’s wide availability, ultrasound is considered now the preferred first line imaging modality in the case of pain. Sonography is operator dependant but it is sensitive means of detecting tendinous pathology& can determine specific causes in most cases.