EMBU evaluation of tendon injuries
Bedside ultrasound evaluation of tendon injuries
Wu, T.S., et al. Am J of Emerg Med 2012; 30:1617-21
Physical exam can be unreliable in evaluating suspected tendon injuries in the ED due to limitations of exam (pain, intoxication, etc) and full range of motion can be preserved in even significant partial tendon tears. More definitive means of diagnosis such as wound exploration or MRI can be time and resource intensive. This study sought to evaluate the accuracy of bedside ultrasound in diagnosing tendon injuries in the ED and whether it could expedite time to diagnosis and discharge.
This was a prospective study of 34 patients suspected to have closed or open tendon injuries at two level 1 trauma centers. Patients were excluded if they had previous tendon injury or required other emergent interventions. Patients first underwent a physical exam of the extremity, after which the physician noted if the patient had a partial, full, or no tear in the tendon. Then the physician performed a bedside ultrasound of the extremity, and noted the degree/presence of tendon injury. Results of the physical exam and EMBU were compared against definitive data acquired by either: 1) wound exploration in the ED, 2) wound exploration in the OR, or 3) MRI. They also noted time to diagnosis based on EMBU, versus time to diagnosis based on wound exploration or MRI.
Ultrasound had an accuracy of 97% and a specificity of 95% in diagnosing tendon injuries, while the physical exam had an accuracy of 85% and a specificity of 76%, though the difference was not statistically significant. Both physical exam and EMBU recognized all 13 tendon injuries (100% sensitivity), while the ultrasound exam diagnosed one false positive and physical exam diagnosed 5 false positives tendon injuries. The median time to diagnosis by ultrasound was significantly faster than by wound exploration/MRI (46.3 min vs 138.6 min, P <0.0005).
Bedside ultrasound can be a good imaging modality for diagnosing tendon injuries in the ED. While we can’t say that it is more accurate than a physical exam based on this study, we know it is has a high specificity and sensitivity and is quicker and less invasive than other methods of diagnosing tendon injuries.