Ultrasound localization of lacerated flexor tendon ends in the hand: a cadaveric study

  • David A. Alvarez
  • David H. BallardEmail author
  • Trevor Carroll
  • Clifton Frilot
  • Alberto A. Simoncini
Scientific Article



Flexor tendon repair currently requires extensive exposure to locate and repair tendons. Ultrasound (US) has been used to identify lacerated tendon ends with little information on accuracy. This study was designed to measure the accuracy of US to localize tendon ends in zone II flexor tendon lacerations in a cadaveric model.

Materials and methods

US was used to locate tendon ends in zone II lacerations of fingers of six cadaveric hands (96 tendon ends) by a musculoskeletal radiologist. The distance of each tendon end relative to the laceration was recorded. Specimens were dissected and tendon position was compared to US position.


The radiologist correctly identified full-thickness lacerations of both superficial and deep tendons 99.0% (n = 05/96 tendons) of the time. The average difference between mean US predicted retraction and anatomic confirmed retraction for all digits all tendons was 3.5 mm of underestimation. US correctly identified the position of all tendon stumps to within 10 mm 92.7% (n = 89/96 tendons) of the time and 69.8% (n = 67/96 tendons) of the time to within 5 mm. Error tended to underestimate (61.5%; 59/96 tendons) rather than overestimate retraction (29.2%; 28/96 tendons).


This fresh cadaveric study has demonstrated that with an experienced radiologist, there was 99.0% accuracy identifying a completed tendon tear and locating the tendon ends with US to within 1 cm was 92.7% accurate.


Flexor tendon Hand ultrasound Tendon injury Tendon surgery Ultrasound 



The authors thank Dr. Anne M Hollister and Alan Ogden for their contributions.


Dr. Ballard receives salary support from National Institutes of Health TOP-TIER grant T32-EB021955.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

Not applicable.

Informed consent

Not applicable.


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Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsLSUHSC-ShreveportShreveportUSA
  2. 2.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  3. 3.Department of Rehabilitation Sciences in the School of Allied Health ProfessionsLSUHSC-ShreveportShreveportUSA
  4. 4.Department of RadiologyLSUHSC-ShreveportShreveportUSA

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