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Abstract: Ultrasound examination is inexpensive, easily accessible and has numerous applications. Its diagnostic or even therapeutic use is developing in the context of hand surgery. The purpose of this work is to review the literature dealing with hand ultrasonograpy by recalling its physical basis and by showing the normal and pathological aspects of different structures and pathologies. [Copyright &y& Elsevier]

Ultrasound examination is inexpensive, easily accessible and has numerous applications. Its diagnostic or even therapeutic use is developing in the context of hand surgery. The purpose of this work is to review the literature dealing with hand ultrasonograpy by recalling its physical basis and by showing the normal and pathological aspects of different structures and pathologies., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

The antibrachial interosseous membrane (IOM) is taught over an average length of 10.6cm between the diaphyses of the radius and ulna bone. It looks like a stitch with fibers running from the ulna to the radius and from proximal to distal and fibers running from distal to proximal. The central band, which is the middle part of the fibers directed from distal to proximal has mechanical properties similar to those of a ligament and act as a ligamentous structure embedded in the larger membranous complex of the IOM. The interosseous membrane has a double function: it stabilizes transversally the forearm's two bones and stabilizes longitudinally the two bones by transferring loads from the radius to the ulna. Load transmission varies according to the prono-supination position, the varus-valgus constraints on the elbow and the inclination of the wrist, making interpretation of the experimental data difficult. One should consider the forearm as a whole and the interosseous membrane with the two diaphyses should be regarded as a middle radio-ulnar joint, intercalated between the proximal and distal radio-ulnar joint. Those three articulations or links between radius and ulna act synergistically to stabilize and optimize repartition of loads. Functional loss of one of these links, and of course of more than one, will severely modify the forearm function. Essex-Lopresti lesion, which represents the functional loss of all three links, is the most destabilizing forearm lesion. Imaging of the interosseous membrane is difficult. MRI allows for static imaging of the interosseous membrane but there are often artifacts due to previous trauma or surgical procedures. Dynamic sonography helps to visualize all the lesions and will probably be part of the evaluation of every severe forearm injury. Surgical treatment depends on the gravity of the lesions of the different links. Interosseous membrane reconstruction is still the most difficult technique and most of the previously reported ligamentoplasties cannot answer all the biomechanical constraints. We describe a ligamentoplasty based on the biomechanics whose technique has been validated by cadaveric experiments. First surgical cases are promising.

Therapeutic options for shoulder joint fractures include conservative treatment or surgery, but indications for either treatment remain vague. Arthroscopic treatment of glenoid fractures and greater tuberosity fractures represents an alternative and allows anatomical reduction and reliable fixation with decreased soft tissue trauma. With this minimally invasive technique, large muscular dissections are avoided and postoperative recovery is shortened. This technique also allows a complete joint inspection and a more accurate diagnosis for associated injuries than conventional imaging methods. Arthroscopy is a useful diagnostic tool that may avoid underestimation of these associated injuries (labrum, rotator cuff tendons, cartilage) and is also helpful for treating these lesions in the same time. However, arthroscopic treatment of shoulder fractures needs a learning curve depending on surgeon's experience in shoulder arthroscopy. At present, indications for arthroscopic treatment of shoulder fractures are limited to anterior or posterior glenoid rim fractures and some greater tuberosity fractures. This selection is best made using preoperative computed tomography and especially 2D reconstruction.