Backhaus et al reported a scoring system for a joint assessment performed using ultrasound. This involved assessments for synovitis, tenosynovitis or paratendonitis, and erosions. The authors are from multiple hospitals in Germany.


Evaluation was performed with gray-scale ultrasound (GSUS) or power Doppler ultrasound (PDUS).


Sites selected: clinically dominant hand


Tenosynovitis on GSUS is a hypoechoic or anechoic thickened tissue with or without fluid within the tendon sheath. Paratendonitis is an echo-poor halo around a tendon which may show increased vascularity on PDUS.


Joint locations assessed for tenosynovitis or paratendonitis: 7 sites at 3 joints



(1) metacarpophalangeal (MCP) II, dorsal aspect

(2) metacarpophalangeal (MCP) II, palmar aspect


(4) metacarpophalangeal (MCP) III, dorsal aspect

(5) metacarpophalangeal (MCP) III, palmar aspect



(1) dorsal

(2) palmar

(3) ulnar


On GSUS the changes were listed as absent (0) or present (1).


Changes on PDUS


no color signals


up to 3 color signals OR (2 single and 1 confluent signal)


grade 1 AND < 50% of intra-articular area filled with color signals


>= 50% of intra-articular area filled with color signals



total score for tenosynovitis and/or paratendonitis on one side =

= SUM(points for all 7 sites)



• minimum score on GSUS: 0

• maximum score on GSUS: 7

• minimum score on PDUS: 0

• maximum score on PDUS: 21


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