High-frequency ultrasound has become an established tool for evaluating hand and finger pathology, offering real-time, high-resolution assessment of superficial soft tissues. The use of linear transducers operating at frequencies ≥15–22 MHz enables detailed visualization of the nail unit, digital nerves, vessels, tendons, and subcutaneous structures.

Fig 1: High-frequency ultrasound anatomy of the finger. Longitudinal and transverse views demonstrate the normal nail bed, nail matrix, distal phalanx, digital arteries, and digital nerve on dorsal, lateral, and volar aspects.

This work is based on a retrospective pictorial review of patients referred for ultrasound evaluation of palpable or symptomatic finger lesions. All examinations were performed using high-frequency linear transducers, with systematic assessment including:

• Lesion location (subungual, periungual, volar, dorsal, lateral)

• Size, shape, margins, and echogenicity

• Relationship to adjacent structures (nerves, joints, nail matrix, tendons)

• Presence of posterior acoustic features

• Vascularity assessed with color and power Doppler

Selected cases were correlated with clinical findings or additional imaging when available.

The reviewed spectrum of lesions includes:

• Synovial cysts and mucoid cysts

• Vascular lesions (hemangioma, pyogenic granuloma, glomus tumor)

• Peripheral nerve sheath tumors (schwannoma and neurofibroma)

• Myofibroma

• Foreign body

• Subungual exostosis

Fig 2: Differential diagnoses of focal finger lesions. Schematic overview of the most lesions encountered on high-frequency ultrasound.