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      Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm

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          Abstract

          The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.

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          US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis.

          Farhad Ebrahim, Michel De Maeseneer, Tjeerd Jager … (2016)
          The thumb is a central component supporting the intricate movements of the hand. Patients with acute thumb pain, particularly after trauma, require prompt evaluation of structural integrity, thus avoiding long-term morbidity such as instability, chronic pain, and osteoarthritis. Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate. US is more dynamic and less time-consuming and may be easier to perform. Furthermore, other disorders such as tenosynovitis, tendon tears, and articular pathologic conditions can involve the thumb and thenar region and may also be diagnosed with US. In this context, US is an underused tool because it is potentially an adjunct to the clinical examination in the appropriate setting. A sound knowledge of the regional anatomy and basic training in the principles of US should equip the imager with the skills necessary to evaluate the UCL of the thumb and its surrounding structures. Copyright RSNA, 2006
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            Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience.

            G.S.J. Chuter, C.L. Muwanga, L.R Irwin (2009)
            Over 10 years in our unit, 127 patients underwent surgical repair of an acute thumb ulnar collateral ligament (UCL) rupture for clinically unstable injuries or displaced avulsion fractures. Ultrasound was used when clinical diagnosis was uncertain. The male/female ratio was 3:2, with a mean age of 40 years (range: 12-81 years). Most of them (> or =66%) were hyper-extension/abduction injuries. The most common cause was a fall (49%), followed by sports injuries; skiing accounted for only 2.4%. Ultrasound was 92% sensitive for UCL ruptures (positive predictive value (PPV) 99%). Over 99% of patients had a UCL rupture confirmed at surgery. Other findings included avulsion fractures (21%), dorsal capsular tears (57%) and dorsal capsule infolding (29%). The most common surgical complication was neurapraxia (6.5%). In our population, thumb UCL injuries are rarely caused by skiing. Ultrasound is a useful, sensitive adjunct in acute diagnosis. Dorsal capsular tears and joint interposition are common. Surgery provides excellent results with few long-term complications.
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              Acute surgical repair of the skier's thumb.

              Graziella Cipriano, R Oden, J Matyas … (1987)
              Complete ulnar collateral ligament tears incurred during the period fall 1977 through spring 1979 were treated under regional anesthesia by a single group of surgeons in an identical fashion as outpatients. Of 123 thumbs repaired, 69 (59%) were available for follow-up examination. There were 34 women and 35 men with an average age of 34.5 years (range, 16-61 years). The follow-up period averaged 31.6 months (range, 16-46 months). Weakness of pinch was described as none or mild in 66 (96%) and significant in only three (4%). Stiffness was described as none or mild in 66 (96%), moderate in two (3%), and severe in one (1%). Pain was described as none or mild in 68 (99%) and moderate in one (1%). Sixty-two patients (90%) preferred outpatient surgery with regional anesthesia whereas only seven (10%) did not. Forty-five (65%) of the 69 patients who required surgery had used traditional poles with straps, suggesting the pole as the causative factor. However, only 20% of noninjured skiers during the 1981-1982 season were using traditional poles with straps, and the total number of complete ulnar collateral ligament repairs did not decrease with the same number of skiers. Therefore, the change in pole design has not decreased the incidence of total ulnar collateral ligament tears. The results of acute surgical repair as an outpatient with regional anesthesia are excellent; 96% of the patients were pleased with the results. If the lesion is overlooked, the results of secondary construction are not nearly as good.
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                Author and article information

                Contributors
                : shelain.patel@doctors.org.uk
                Journal
                Journal ID (nlm-ta): Strategies Trauma Limb Reconstr
                Title: Strategies in Trauma and Limb Reconstruction
                Publisher: Springer Milan (Milan )
                ISSN (Print): 1828-8936
                ISSN (Electronic): 1828-8928
                Publication date (Electronic): 6 February 2010
                Publication date PMC-release: 6 February 2010
                Publication date (Print): April 2010
                Volume: 5
                Issue: 1
                Pages: 1-10
                Affiliations
                Department of Trauma and Orthopaedics, University College Hospital, 235 Euston Road, London, NW1 2BU UK
                Article
                Publisher ID: 79
                DOI: 10.1007/s11751-010-0079-7
                PMC ID: 2839319
                PubMed ID: 20360873
                SO-VID: 10ccd67f-71c7-4956-ba0f-e3e39f5208b8
                Copyright © © Springer-Verlag 2010
                History
                Date received : 24 October 2009
                Date accepted : 15 January 2010
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2010

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: metacarpophalangeal joint,radial collateral ligament,ulnar collateral ligament,algorithm,thumb
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: metacarpophalangeal joint, radial collateral ligament, ulnar collateral ligament, algorithm, thumb

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