How well can an expert examiner detect synovitis of the fingers?

Summary:

Even an expert has difficulty and only detected by palpation 25% of finger joints that had swelling by ultrasounds.

Patients:

The authors examined 165 finger tendons from “33 consecutive patients who has originally presented with polyarthritis and clinical suspicion of inflammatory arthritis of the hands and wrists (symptoms < 24 months)”

Examiner:

“senior rheumatologist trained in the detection of musculoskeletal disorders (AS), who disregarded ultrasonography findings”

Reference standard:

Ultrasound

Results:

52% (17 patients) had flexor tenosynovitis by ultrasound.

Performance of the expert clinical examiner.

	Sensitivity (%)	Specificity (%)
Tenderness	87	47
Crepitus	56	76
Swelling	25	100

Citation:

Hmamouchi I, Bahiri R, Srifi N, Aktaou S, Abouqal R, & Hajjaj-Hassouni N (2011). A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis. BMC musculoskeletal disorders, 12 PMID: 21549008

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