Sound Findings on Hand Dynamics: Validation and Application of Ultrasound Speckle Tracking of Tendon and Nerve Dynamics

Dynamic imaging of the hand and wrist would give valuable insight in the complex interaction between tendons, nerves, and their surrounding tissue also called subsynovial connective tissue (SSCT) during hand movements. Furthermore, it could provide clinicians and therapists with valuable information to objectively diagnose patients, or to follow progress in patients over time making it easier to intervene when necessary. However, the dynamic behavior of the hand and its tendons and nerves is hard to capture with a clinical imaging modality, let alone to quantify its behavior. Therefore we have developed an ultrasound tracking algorithm capable of quantifying tendon, nerve, and their surrounding tissue excursions with an accuracy of less than 300μm. We have assessed the added clinical value of our algorithm in two major groups of hand injuries, namely CTS and hand tendon injuries. It is hypothesized that patients suffering from CTS have changes in the SSCT thereby altering the tendon and nerve dynamics. Using our algorithm we found that patients having carpal tunnel syndrome (CTS) had a different approach in using their hand flexor tendons to make a fist. These differences allowed us to classify up to 86% of the patients as having CTS. Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon surgery that aim at adhesion prevention by adequate tendon excursion exercises. Although almost all mobilization protocols only focus on the injured finger, studies have suggested that the position of the neighboring injured fingers influences tendon excursions of the injured finger. We found that the position of the adjacent fingers has a significant influence on the hand flexor tendon excursion of the injured finger, increasing tendon excursion up to 44% and possibly decrease tendon adhesions.

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