SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
distally. A ring formed by the SDFT surrounds the proximal portion of the DDFT.
The trapezoid shaped SDSL lies dorsal to the DDFT throughout its length. The
branches of the MDSL are round to oval structures dorsolateral and dorsomedial
to the SDSL originating from the base of the lateral and medial proximal sesamoid
bones, respectively. The cruciate distal sesamoidean ligament (CDSL) can be
identified near the palmar aspect of the proximal border of P1, just distal to the
base of the proximal sesamoid bones.
P1B
This zone is the middle of the first phalanx where the MDSL inserts on mid P1.
The SDFT is divided into teardrop shaped lateral and medial branches. The
branches have a homogeneous echogenicity in the transverse plane and a
parallel fiber pattern in the longitudinal plane. The bilobed appearance of the
DDFT persists in this zone. Anechoic synovial fluid within the digital sheath is
often imaged dorsal to the DDFT. The SDSL is dorsal to the DDFT and palmar or
plantar to the insertion of the MDSL. In the mid pastern region the SDSL has its
smallest cross-sectional area and an oval shape. The medial and lateral branches
of the MDSL join to form one rectangular ligament that inserts in this zone on the
middle of the palmar/plantar aspect of P1.
P1C
This zone is in the distal first phalanx, distal to the insertion of the MDSL. The
SDFT branches before their insertion have a more triangular shape and a larger
cross sectional area. The more dorsal DDFT remains bilobed. The SDSL
becomes larger before it inserts onto proximal P2 at the scutum medium.
Anechoic fluid may be imaged in the palmar/plantar aspect of the digital sheath.
P2A
In the proximal portion of the second phalanx the bilobed DDFT is the most
palmar/plantar structure. The SDSL becomes wider in a medial to lateral plane
before it inserts on the scutum medium on proximal aspect P2. A normal
hypoechoic central area can often be imaged in the transverse plane at the
insertion of the SDSL onto proximal P2.
P2B
In the distal portion of the second phalanx the DDFT and the distal aspect of the
digital sheath can be imaged running along the palmar/plantar aspect of P2, towards
its insertion on the palmar/plantar aspect of P3. A curved microconvex linear array
transducer is needed to image this area.
Sonographic assessment of injury severity
The severity of tendon injury should be characterized ultrasonographically.
Assessments of tendon or ligament cross-sectional area at its largest point in each
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