Thumb ultrasound: Technique and pathologies
Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

The intricate anatomy of the thumb has evolved over millions of years and allows us to perform delicate precision tasks and gives a powerful grip to the hand. Accurately scanning the thumb can be challenging and time consuming for a beginner due to its relatively small size and complex anatomy. There are many situations where ultrasound is found to be a superior imaging investigation than magnetic resonance imaging (MRI) because of its dynamic nature, better resolution for smaller structures, low cost, and because it is easy and quick to use in trained hands. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

The standard ultrasound examination of the thumb begins with the patient sitting in front of the examiner with their hand on a pillow. Good-quality ultrasound equipment and a high-frequency (12–15 MHz) linear-array (with a flat surface) probe is required. A dedicated smaller and convenient hockey stick probe can also be used, especially to assess ulnar collateral ligament. The probe should be held at its end with the edge of the hand resting on the pillow in order to reduce stress and allow fine motor control. A gel stand should be used to improve visualization by reducing pressure on soft structures. Obtaining a brief history at the beginning of the examination can provide clues to the underlying pathology.

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