Soft-tissue changes in the hand in rheumatoid arthritis: evaluation with US.

High-frequency (5.0 and 7.5 MHz) ultrasonography (US) was performed in 16 patients with rheumatoid involvement of soft tissues in the hand or wrist; surgery was performed in 11. In 15 (94%) patients, a hypoechoic thickening of one or several tendon sheaths was noted. The thickening ranged from 2 to 13 mm (mean, 5.2 mm +/- 3.0). Complete or partial flexor tendon ruptures were correctly suspected preoperatively at real-time dynamic US examination in three patients. A discrete, elongated, hypoechoic soft-tissue nodule was demonstrated in five patients; one nodule was intra-tendinous. In 10 of 11 patients, US findings correlated well with those of surgery. Real-time US proved highly accurate in demonstrating rheumatoid soft-tissue changes in the hand. A hypoechoic rim around a tendon in the hand or wrist in a patient with rheumatoid arthritis is highly suggestive of rheumatoid tenosynovitis. US also provides surgeons with an accurate preoperative map of the lesions.