Water bath evaluation technique for emergency ultrasound of painful superficial structures.

Researchers have described the use of bedside emergency ultrasound as an effective way to evaluate for and accurately drain potential abscesses. Similarly, descriptions exist of long bone fracture evaluation in the wrist and hands. Tendon injury can also be detected with ultrasound and exploration can be obviated or at least focused. Sonographic examination of painful extremity pathology such as abscesses or lacerations involving the hand or foot can be challenging. Patients may be uncooperative if they experience significant pain when the transducer is placed on the area of interest. While ample amounts of ultrasound gel can decrease the need for firm transducer contact with the skin it is still difficult to obtain a good evaluation without causing any discomfort. The solution may lie in an old technique that has been recently brought back to life for use in hand evaluation in which the patient's extremity is placed in a water bath. The water bath replaces the need for ultrasound gel or contact between the ultrasound transducer and the patient's skin, thus eliminating discomfort. We describe 7 cases in which, despite aggressive attempts at pain control, adequate evaluation of extremity pathology was not possible without the use of the water bath technique. Patients reported no discomfort and superior quality images were obtained due to the water bath properties. Emergency sonologists should keep this technique in mind when contact between skin and the ultrasound transducer is likely to cause a patient significant discomfort.

Fractures of the terminal phalanx presenting as a paronychia.

Three fractures at the base of the terminal phalanx of the finger and one at the base of the terminal phalanx of the tow were initially misdiagnosed as paronychias. If a 'paronychia' follows trauma, the possibility of a fracture should be considered and radiographs taken of the digit.

[X-ray diagnosis of complications of purulent processes in the wrist]. / K rentgenodiagnostike oslozhnenii gnoinykh protsessov kisti.

To reveal the spreading of a purulent process to the antebrachial fatty spaces a study was made of an x-ray picture of soft tissues of the radiocarpal articulation and the forearm distal half in 126 patients with hand paronychia and phlegmon. In 24 of 95 patients with an unclear clinical picture of purulent discharge, typical x-ray symptoms of changes in soft tissues of the distal third of the forearm were found: typical deformity of fatty spaces with its distinct dynamics with relation to a stage of development of a pathological process. X-ray investigation permits the recognition of complications in hand purulent processes in order to take necessary therapeutic measures.

[Differential diagnosis of changes in density and structure of the foot bones]. / Differentialdiagnose der Dichte- und Strukturveränderungen des Fussskelets.

Skeletal disorders of the foot can be assessed radiologically by changes in bone density, structure and/or form. The knowledge of specific morphological criteria is a precondition for differential diagnosis. Our classification of skeletal disorders of the foot is based on the specific signs that can be observed in systemic and local diseases affecting the pedal bones.

Osteomyelitis and septic arthritis complicating hand injuries and infections: pathogenesis of roentgenographic abnormalities.

Osteomyelitis and pyarthrosis may complicate hand injuries and soft-tissue infections, resulting in characteristic radiographic findings. Evaluation of 78 patients revealed bone or joint abnormalities in 10% of individuals. Distinct pathways are available for spread of bacteria which become lodged in the soft tissues of the hand. Such routes include tendon sheaths, fascial planes and lymphatics. An understanding or pertinent anatomy allows the radiologist to predict the site and pattern of soft tissue, articular and osseous alterations.