Ulnar collateral ligament injuries of the first metacarpophalangeal joint: prevalence of associated injuries on radiogra
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SCIENTIFIC ARTICLE
Ulnar collateral ligament injuries of the first metacarpophalangeal joint: prevalence of associated injuries on radiographs and MRI Sebastian Manneck 1 & Filippo Del Grande 2 & Anna Hirschmann 1 Received: 22 May 2020 / Revised: 5 August 2020 / Accepted: 5 August 2020 # The Author(s) 2020
Abstract Purpose To evaluate the prevalence of associated findings at the first metacarpophalangeal joint on radiographs and MRI following acute ulnar collateral ligament (UCL) injuries. Materials and methods This retrospective study included 25 patients with an injury of the UCL at MRI. Presence of associated injuries to the volar ligaments (checkrein and phalangoglenoid ligaments and volar plate) was assessed on radiographs and MRI independently by two musculoskeletal radiologists. Wilcoxon signed-rank test was used to compare frequencies of injuries between both modalities (p < 0.05). Interreader variability was calculated. Results Complete tears of the UCL (48%/60%, reader 1/2) were more common than partial tears (24%/16%) on MRI. Dislocation of the UCL ≥ 3 mm was detected in 40%/56% on MRI. UCL avulsion fractures were more frequently seen on MRI (28%) compared with radiographs (12%) for reader 1. Associated avulsion injuries of the phalangoglenoid ligament were evident in 12%/8% on radiographs and in 80%/76% on MRI. Almost all patients (100%/79%) with a dislocated UCL tear showed a concomitant volar ligament injury; and even two-thirds (66%/72%) of the non-displaced UCL tears had an injury to the volar ligaments. Interreader agreement was moderate to excellent (κ = 0.60–1.0). Conclusion UCL tears are often associated with volar ligament injuries, even in lesser degrees of an UCL injury. Keywords Ulnar collateral ligament . Volar plate . Thumb . Metacarpophalangeal joint . MRI . Hand injuries . Radiographs
Abbreviations FS Fat-saturated ICC Intraclass correlation coefficient IW Intermediated-weighted MCP joint Metacarpophalangeal joint MRI Magnetic resonance imaging RCL Radial collateral ligament ST Slice thickness UCL Ulnar collateral ligament * Sebastian Manneck [email protected] Filippo Del Grande [email protected] Anna Hirschmann [email protected] 1
Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland
2
Department of Radiology, Ospedale Regionale di Lugano, 6900 Lugano, Switzerland
Introduction The ulnar collateral ligament (UCL) is the primary stabilizer of the first metacarpophalangeal (MCP) joint during valgus stress. Injuries of the UCL typically occur as a result of hyperabduction and may be accompanied by hyperextension of the thumb. UCL tears most commonly occur at the distal insertion and the stump may be displaced. Surgical therapy is recommended if the displacement is more than 3 mm [1] and required if the displacement is proximal to the adductor aponeurosis, also known as Stener lesion [2]. A misdiagnosed or improperly treated injury may result in joint instability, leading to significant disability and pain
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