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

Abstract

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.

Keywords: Bedside ultrasound; Hand fractures; Nailbed injury; POCUS; Trigger finger.

Figure 1

Flow diagram of literature screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria included: (1) patient(s) with diagnoses of tendon injuries, ganglion cysts, fractures, trigger digits, carpal tunnel syndrome, ligament injuries, nerve entrapments, and soft tissue injuries or masses; (2) patient(s) where point-of-care ultrasound was used to assist with diagnosis or management; (3) outcomes reported measure diagnostic accuracy (sensitivity, specificity) or time to diagnosis, procedural success rates, and patient outcomes (pain relief, functional improvement); (4) studies that were prospective in nature; and (5) data in the English language.

Figure 2

Forest plot of the sensitivity of point-of-care ultrasound (POCUS) in diagnosing hand and wrist fractures. The pooled sensitivity across included studies was 0.820 (95% CI, 0.78–0.853), with substantial heterogeneity (τ² = 4.06). Each horizontal line represents the 95% confidence interval for sensitivity in an individual study. The vertical dashed line indicates the pooled estimate.

Figure 3

Forest plot of the specificity of point-of-care ultrasound (POCUS) in diagnosing hand and wrist fractures. The pooled specificity was 89.39% (95% CI, 87.12% to 91.30%), with moderate heterogeneity (τ² = 0.60). Each horizontal line represents the 95% confidence interval for specificity in an individual study. The vertical dashed line indicates the pooled estimate.

Figure 4

Summary receiver operating characteristic (SROC) curve of point-of-care ultrasound (POCUS) for diagnosing hand fractures. Each blue point represents an individual study’s sensitivity and 1 – specificity on the SROC curve. The solid curve represents the fitted SROC from the bivariate meta-analysis model. The inner ellipse denotes the 95% confidence region around the pooled estimate, while the outer ellipse shows the 95% prediction region, reflecting variability across studies.