Would an electroencephalogram (EEG) be used to diagnose a genetic problem with tendons causing bilateral hand pain?

Electroencephalogram (EEG) Is Not Appropriate for Diagnosing Genetic Tendon Disorders Causing Bilateral Hand Pain

An electroencephalogram (EEG) is not an appropriate diagnostic tool for evaluating genetic problems with tendons causing bilateral hand pain. Instead, ultrasound or MRI without IV contrast are the recommended imaging modalities for diagnosing tendon pathology in the hands 1.

Appropriate Diagnostic Approach for Tendon-Related Hand Pain

Initial Evaluation

• Radiography (X-rays) is the appropriate initial imaging study for chronic hand or wrist pain 1
• This helps rule out bony abnormalities or arthritis that may contribute to symptoms

Next Imaging Studies for Tendon Pathology

When radiographs are normal or show only nonspecific arthritis and tendon pathology is suspected:

1. Ultrasound (US):

   • Highly recommended for tendon evaluation due to:
     • Superficial location of hand/wrist tendons
     • Ability to dynamically assess tendons during movement
     • Can diagnose tendinopathy, tendon tears, tenosynovitis, and stenosing tenosynovitis 1

2. MRI without IV contrast:

   • Excellent contrast resolution for soft tissue assessment
   • Can diagnose various tendon abnormalities including tendinopathy, tendon tears, and tenosynovitis 1
   • Particularly useful when deeper structures need evaluation

Why EEG Is Not Appropriate

EEG is a neurophysiological test that records electrical activity of the brain and is primarily used for:

• Diagnosing seizure disorders
• Evaluating encephalopathy/encephalitis
• Distinguishing psychiatric from organic causes of altered mental status 1

EEG has no role in diagnosing tendon disorders or musculoskeletal conditions. The American College of Radiology guidelines make no mention of EEG for evaluating tendon pathology 1.

Genetic Aspects of Tendon Disorders

While genetic factors can contribute to tendon disorders:

• More than 18 genomic intervals have been implicated in tendinopathy risk models 2
• Genetic testing (not EEG) would be the appropriate diagnostic approach for suspected hereditary connective tissue disorders like Ehlers-Danlos syndromes 3

Treatment Considerations

For tendon disorders causing bilateral hand pain, the American College of Rheumatology recommends:

• Corticosteroid injections (limited to 2-3 injections with 4-6 weeks between each) 4
• NSAIDs as first-line drug treatment 4
• Acetaminophen as an alternative analgesic 4
• Eccentric strengthening exercises 4

Common Pitfalls to Avoid

1. Misdiagnosis: Bilateral hand pain may be confused with carpal tunnel syndrome, which has a high prevalence of bilateral involvement (80.7%) 5. However, CTS is diagnosed with nerve conduction studies/electromyography (not EEG).

2. Inappropriate imaging: Using EEG instead of appropriate musculoskeletal imaging wastes resources and delays proper diagnosis.

3. Missing genetic disorders: When bilateral hand symptoms suggest a genetic disorder, targeted genetic testing should be considered rather than neurophysiological testing 3, 6.

In conclusion, for patients with suspected genetic problems affecting tendons and causing bilateral hand pain, the diagnostic pathway should begin with radiography, followed by ultrasound or MRI without contrast. Genetic testing may be appropriate if a hereditary connective tissue disorder is suspected, but EEG has no role in this diagnostic algorithm.