Abstract
Purpose
To retrospectively characterize the ultrasound appearance of displaced ulnar collateral ligament (UCL) tears that are proven at surgery, and then determine the accuracy of the resulting ultrasound criteria in differentiating displaced from non-displaced UCL tears.
Materials and methods
After institutional review board approval, 26 patients were identified from the radiology information system over a 10-year period that had ultrasound evaluation of the thumb and surgically proven UCL tear. Retrospective review of the displaced full-thickness tears was carried out to characterize displaced tears and to establish ultrasound criteria for such tears. A repeat retrospective review 4 months later of all UCL tears applied the criteria to determine accuracy of ultrasound in the diagnosis of displaced full-thickness UCL tear.
Results
The 26 subjects consisted of 17 displaced full-thickness UCL tears, seven non-displaced full-thickness tears, and two partial-thickness tears at surgery. Retrospective ultrasound review of displaced full-thickness tears identified two criteria present in all cases: non-visualization of the UCL ligament and presence of a heterogeneous mass-like area proximal to the first metacarpophalangeal joint. Applying these criteria at the second retrospective review resulted in 100 % sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.
Conclusions
The ultrasound findings of absent UCL fibers and presence of a heterogeneous mass-like abnormality proximal to the first metacarpophalangeal joint achieved 100 % accuracy in differentiating displaced from non-displaced full-thickness UCL tear of the thumb. Displaced full-thickness UCL tears most commonly were located proximal to the adductor aponeurosis.
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References
Hinke DH, Erickson SJ, Chamoy L, Timins ME. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper’s thumb). AJR Am J Roentgenol. 1994;163:1431–4.
Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 2010;20:106–12.
Helm R. Hand function after injuries to the collateral ligaments of the metacarpophalangeal joint of the thumb. J Hand Surg (Br). 1987;12:252.
Schnur DP, DeLone FX, McClellan RM, Bonavita J, Witham RS. Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg. 2002;49:19–22. discussion 22–13.
Resnick D, Danzig LA. Arthrographic evaluation of injuries of the first metacarpophalangeal joint: gamekeeper’s thumb. AJR Am J Roentgenol. 1976;126:1046–52.
Downey Jr EF, Curtis DJ. Patient-induced stress test of the first metacarpophalangeal joint: a radiographic assessment of collateral ligament injuries. Radiology. 1986;158:679–83.
Hoglund M, Tordai P, Muren C. Diagnosis by ultrasound of dislocated ulnar collateral ligament of the thumb. Acta Radiol. 1995;36:620–5.
Ebrahim FS, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA. US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics. 2006;26:1007–20.
Spaeth HJ, Abrams RA, Bock GW, et al. Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress. Radiology. 1993;188:553–6.
Resnick D, Kang HS. Internal derangements of joints: emphasis on MR imaging. Philadelphia: Saunders; 1997. p. 951. viii.
Shinohara T, Horii E, Majima M, et al. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound. 2007;35:73–7.
Hergan K, Mittler C, Oser W. Pitfalls in sonography of the gamekeeper’s thumb. Eur Radiol. 1997;7:65–9.
Susic D, Hansen BR, Hansen TB. Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb. Scand J Plast Reconstr Surg Hand Surg. 1999;33:319–20.
Hergan K, Mittler C. Sonography of the injured ulnar collateral ligament of the thumb. J Bone Joint Surg Br. 1995;77:77–83.
Canella Moraes Carmo C, Cruz GP, Trudell D, Hughes T, Chung C, Resnick D. Anatomical features of metacarpal heads that simulate bone erosions: cadaveric study using computed tomography scanning and sectional radiography. J Comput Assist Tomogr. 2009;33:573–8.
Kataoka T, Moritomo H, Miyake J, Murase T, Yoshikawa H, Sugamoto K. Changes in shape and length of the collateral and accessory collateral ligaments of the metacarpophalangeal joint during flexion. J Bone Joint Surg Am. 2011;93:1318–25.
Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb: a clinical and anatomical study. J Bone Joint Surg Br. 1962;44:869–79.
Chuter GSJ. Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Inj Int J Care Injured. 2009;40:652–6.
Campbell CS. Gamekeeper’s thumb. J Bone Joint Surg Br. 1955;37-B:148–9.
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Melville, D., Jacobson, J.A., Haase, S. et al. Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. Skeletal Radiol 42, 667–673 (2013). https://doi.org/10.1007/s00256-012-1519-x
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DOI: https://doi.org/10.1007/s00256-012-1519-x