Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis

Abstract

ObjectiveTo assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility.MethodsSubjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC.ResultsWe analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L.ConclusionsA negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.

Evaluation of the Coronal Malposition of the Volar Locking Plate in the Treatment of Distal Radius Fractures

“…It has been reported in the literature that USG can be used to determine and score tendon complications. USG has also been used to investigate flexor tendinopathies in patients treated with volar plate fixation of distal radius fractures [13][14][15][16]. We studied the FPL tendon in particular, since it is the closest tendon to bone and, as it is the closest tendon to bone and, therefore, the closest tendon to the volar plate [13,15,16].…”

“…One study reported on the amount of tendosynovitis found on USG, related to symptomatic and asymptomatic tendon issues after plate implantation [ 13 ]. Another study scored the amount of tenosynovitis with USG in patients with rheumatoid arthritis [ 14 ]. Another study reported that the extensor tendon complications and dorsal screw penetrations were detected through USG examination in patients who were treated with internal fixation with a volar plate.…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…US-guided intra-tenosynovial GC injections are more accurate, safer, and are more effective than palpatory GC injections for treating inflammatory tenosynovitis [336,337]. When needed for diagnostic purposes, very small amounts of tenosynovial fluid can be easily aspirated using US guidance [338]. US-guided GC intra-bursal injection is effective and safe for treating refractory Achilles enthesitis in patients with SpA [339].…”

A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study

“…Additionally, color Doppler ultrasound facilitates the observation of internal structure changes and blood flow in lymph nodes. [4,5] The versatility of color Doppler ultrasound technology is evident in various clinical diagnostic applications. [6] Alis et al [7] investigated the efficacy of Superb microangiography and power Doppler ultrasound in diagnosing synovial inflammation of the knee joint in patients with juvenile idiopathic arthritis, with power Doppler ultrasound imaging demonstrating superiority.…”