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Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To determine the performances of clinical examination, ultrasonography, and MRI for diagnosing non-displaced and displaced ulnar collateral ligament (UCL) tears.

Methods

Based on a literature search of Medline, ISI Web of Science, Embase, and Scopus between January 1990 and December 2019, all published original articles which met the inclusion criteria were included. We determined the pooled sensitivities, specificities, and accuracies of clinical examination, ultrasonography, and MRI using a meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Diagnostic Test Accuracy (PRISMA-DTA) guidelines.

Results

A total of 17 studies with 519 subjects reporting diagnostic performances of clinical examination (8), ultrasonography (12), and MRI (5) met the inclusion criteria. For ruling out UCL tears, the pooled sensitivities were similarly high for clinical examination (97% (95% confidence interval [CI], 93–99%)), ultrasonography (96% (95% CI, 94–98%)), and MRI (99% (95% CI, 92–100%)) (p = 0.3). For ruling in UCL tears, the pooled specificities were higher for MRI (100% (95% CI, 87–100%)) when compared to ultrasonography (91% (95% CI, 86–95%)) (p = 0.1) and clinical examination (85% (95% CI, 78–91%)) (p = 0.04). For the diagnosis of displaced UCL tears, MRI had a higher specificity (92% (95% CI, 73–99%)) than ultrasonography (72% (95% CI, 63–80%)) (p = 0.2).

Conclusions

Clinical examination, ultrasonography, and MRI have similarly high sensitivities for ruling out UCL tears in patients presenting with a thumb injury. MRI and ultrasonography have high specificities to confirm the presence of suspected UCL tears. MRI performs best for differentiating non-displaced from displaced UCL tears.

Key Points

• Clinical examination followed by ultrasonography is the most appropriate test for ruling out ulnar collateral ligament (UCL) tears of the thumb.

• MRI and ultrasonography both have high specificities to confirm the presence of a suspected UCL tear.

• MRI outperforms ultrasonography for differentiating non-displaced from displaced UCL tears.

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Abbreviations

CI:

Confidence interval

DOR:

Diagnostic odds ratio

UCL:

Ulnar collateral ligament

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA

    Ali Rashidi & Arya Haj-Mirzaian

  2. Nuffield Orthopedic Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Danoob Dalili

  3. Radiology, Balgrist University Hospital, Zurich, Switzerland

    Benjamin Fritz

  4. Faculty of Medicine, University of Zurich, Zurich, Switzerland

    Benjamin Fritz

  5. Department of Radiology, Musculoskeletal Radiology, New York University Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm #313, New York, NY, 10016, USA

    Jan Fritz

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Correspondence to Jan Fritz.

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The scientific guarantor of this article is Jan Fritz.

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Ali Rashidi, Arya Haj-Mirzaian, Danoob Dalili, and Benjamin Fritz declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Jan Fritz:

American College of Radiology: Board or committee member

American Roentgen Ray Society: Board or committee member

Association of University Radiologists: Board or committee member

International Society of Magnetic Resonance in Medicine: Board or committee member

Society of Skeletal Radiology: Board or committee member

European Society of Skeletal Radiology: Board or committee member

Radiological Society of North America: Board or committee member

GE Healthcare: Unpaid consultant

Siemens AG: Paid presenter or speaker; Research support; Unpaid consultant

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Current Radiology Reports: Editorial or governing board

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Rashidi, A., Haj-Mirzaian, A., Dalili, D. et al. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Eur Radiol 31, 5699–5712 (2021). https://doi.org/10.1007/s00330-020-07666-z

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