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Musculoskeletal and Sports Medicine

Utility of Ultrasound in Acute Soft Tissue Injuries of the Hand: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 2
Disclosure(s):
Zachary Poche, MD: No financial relationships to disclose
Robert P. Owens, MD: No relevant disclosure to display
Case Diagnosis: This is a 65-year-old female with acute right-hand pain due to rupture of the right extensor digitorum communis (EDC) extensor hood at the 3rd MCP joint.

Case Description or Program Description: A 65-year-old female presented for evaluation of right-hand pain for 1 month. The pain started when she struck the dorsum of her right hand on a wooden table. The pain was primarily located along the dorsal aspect of the right 3rd metacarpophalangeal (MCP) joint. The patient was previously evaluated in the emergency department (ED), who obtained x-rays which noted no acute fractures. Physical exam was notable for significant edema over the right 3rd MCP joint as well as exquisite tenderness to palpation over the same region. Upon active range of motion of the right fingers, the patient had a clicking sensation at the right 3rd MCP joint with active finger extension and finger flexion.

Setting: Outpatient PM&R Clinic in a Tertiary Hospital

Assessment/Results: Diagnostic ultrasound was then performed which revealed rupture of the right extensor digitorum communis (EDC) extensor hood at the 3rd MCP joint. The patient was then referred to hand specialist who performed a local, peritendinous corticosteroid injection which did not provide significant functional improvement. Patient then elected to proceed with surgical repair

Discussion (relevance): This soft tissue injury would not have been discovered in a timely manner without proficient diagnostic ultrasound skills. Magnetic resonance imaging (MRI) would have been an option for further evaluation, but proficient diagnostic ultrasound skills allow a clinician to extend their physical exam in a way that is otherwise not possible.

Conclusions: This case should serve as a reminder to consider an extensor sheath rupture when evaluating a patient with acute hand pain with non-diagnostic x-rays as well as the overall utility in musculoskeletal ultrasound in acute soft tissue injuries of the hand.