Integrating Point-of-Care Ultrasound in Hand Clinic: A Systematic Review and Meta-Analysis

Purpose

Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable adjunct to physical examination in various clinical settings. Despite this, integration into the routine clinical practice of hand surgeons remains limited. This systematic review and meta-analysis aims to evaluate the diagnostic and clinical utility of POCUS in hand clinics for the assessment and management of common hand pathologies.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE and Embase were searched. Prospective studies evaluating POCUS use in hand pathologies were included. Two reviewers independently screened, extracted, and assessed data. Meta-analysis of diagnostic performance measures was conducted using a bivariate random effects model when appropriate.

Results

Fifteen prospective studies involving 1,217 patients were included. POCUS was most commonly used to assess fractures (76.3%) and tendinous pathologies (20%). For hand fractures, pooled sensitivity and specificity were 81.95% (95% confidence interval [CI]: 78.03% to 85.31%) and 89.39% (95% CI: 87.12% to 91.30%), respectively. Among tendinous pathologies, POCUS demonstrated 100% sensitivity for trigger digits in three of four included studies. Limited evidence also supported high diagnostic performance for nail bed injuries (sensitivity: 97%, specificity: 95%).

Conclusions

POCUS demonstrates high diagnostic accuracy for evaluating hand fractures and tendinous injuries while showing promise in the evaluation of nail bed trauma. Heterogeneity in study design, operator expertise, and reference standards was noted.

Clinical relevance

The incorporation of POCUS into the clinical practice of hand surgeons, supported by formal training and technological advancements such as artificial intelligence integration, may improve diagnostic efficiency, guide management, and enhance care delivery.