Ultrasound of Focal Lesions of the Hand and Wrist: Accuracy, Validity, and Factors Determining Treatment Decision
Thumanoon Ruangchaijatuporn MD1, Nattaree Chunlertrith MD1, Suphaneewan Jaovisidha MD1, Patarawan Woratanarat MD, PhD2
Affiliation : 1 Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 2 Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To estimate the accuracy and validity of ultrasound in evaluating focal lesions of the hand and wrist and determine the
factors affecting the treatment.
Materials and Methods : Eighty focal lesions were enrolled and divided into two groups (surgical and non-surgical group). The
lesions in each group were subclassi(cid:976)ied as cystic, solid, vascular, and in(cid:976)lammation or infectious lesion, using either pathological,
or ultrasound diagnosis as the reference.
Results : The accuracy of ultrasound was low at 57%, 54%, 29%, and 25% for cystic, solid, vascular lesion, and in(cid:976)lammatory or
infectious lesion, respectively. There was no signi(cid:976)icant difference between the ultrasound and clinical diagnosis for hand and
wrist lesions (p-value 0.8793). Based on pathological (cid:976)indings, all lesions in the study were benign. The factors that were found
to in(cid:976)luence treatment (surgical versus non-surgical) in the present study relied on the ultrasound (cid:976)indings and size of the lesion.
The ultrasound report of cyst or in(cid:976)lammatory or infectious tended to be followed by conservative treatment (73% and 90%,
respectively). On the other hand, surgical treatment was performed if the ultrasound reports resulted as solid or vascular lesion
(60% and 67%, respectively) or regarding to the larger size as well (2.5±1.8 cm in surgical versus 1.5±1.1 cm in non-surgical group).
Conclusion : The accuracy of ultrasound evaluation of focal lesions in the hand and wrist is low (25% to 57%). However, the lesions
with larger size or the solid and vascular lesions had more tendency to undergo surgery. Therefore, ultrasound may help suggesting
the therapeutic decision.
Keywords : Ultrasound, Hand and wrist, Focal lesion, Accuracy, Treatment
