Anatomy of the Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

Carlson, Michelle G.; Warner, Kristin K.; Meyers, Kathleen N.; Hearns, Krystle A.; Kok, Peter L.

doi:10.1016/j.jhsa.2012.06.024

Cited by 47 publications

(26 citation statements)

References 15 publications

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“…1). Anatomic study of the UCL has determined the center of origin to be 4.2 mm from the dorsal surface and 5.3 mm proximal to the articular surface of the metacarpal head and inserting 2.8 mm from the volar surface and 3.4 mm distal to the phalangeal base [13].…”

Section: Anatomymentioning

confidence: 99%

“…The RCL is 4-8 mm wide and 12-14 mm long [8]. A recent anatomic study defined the center of the RCL origin at the metacarpal as 3.5 mm from the dorsal surface and 3.3 mm from the articular surface, with the center of the RCL insertion on the proximal phalanx as 2.8 mm from the volar surface and 2.6 mm from the articular surface [13]. The width of the RCL insertion may be greater than that of the RCL origin [58], which may explain why proximal tears occur more frequently than distal tears [59].…”

Section: Anatomymentioning

confidence: 99%

See 1 more Smart Citation

Thumb collateral ligament injuries in the athlete

Avery

Inkellis

Carlson

2017

Curr Rev Musculoskelet Med

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Purpose of review The purpose of this review is to identify current principles in the diagnosis and treatment of collateral ligament injuries of the thumb in the athlete. Recent findings Cadaver studies have clearly identified the ulnar and radial collateral ligaments origin and insertion footprints for repair or reconstruction. Summary Ulnar and radial collateral ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/ reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author's preferred techniques are reported.

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Section: Anatomymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

Thumb collateral ligament injuries in the athlete

Avery

Inkellis

Carlson

2017

Curr Rev Musculoskelet Med

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“…8) Acute injuries are the result of a sudden, significant radial force causing abduction of the thumb. [9][10][11] The results of stress testing of the thumb MCP joint help to determine whether treatment will be non-operative with immobilization or with surgical reconstruction or repair. Fluoroscopy, MRI and ultrasound are increasingly being used and evaluated as diagnostic tools.…”

Section: Discussionmentioning

confidence: 99%

Can Physical Examination Create a Stener Lesion?

Lankachandra

Eggers

Bogener

et al. 2017

J Hand Surg Asian-Pac Vol

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Background: The purpose of this study is to determine whether a Stener lesion can be created while testing stability of the ulnar collateral ligament (UCL) of the thumb. Testing was performed in a manner that reproduced clinical examination. Methods: Six fresh frozen hand and forearm specimens underwent sequential sectioning of the accessory UCL, the proper UCL, and the ulnar sagittal band. Measurements of radial deviation of the metacarpophalangeal (MCP) joint were taken with the thumb in neutral rotation, pronation and supination, both with 0 degrees and with 30 degrees of flexion of the MCP joint. Visual examination was performed to assess the presence of a Stener lesion. Results: No Stener lesion was created in any position as long as the fascial origin of the ulnar sagittal band at the adductor pollicis longus remained intact. After creating a defect in the ulnar sagittal band, a Stener lesion was created in two specimens, but only when the thumb was flexed and supinated. Pronation provided more stability, and supination provided less stability, with one or both components cut, especially when testing at 30° of flexion. Compared to both components cut without flexion or rotation, there was a statistically significant difference in angulation with the 30 degrees of MCP joint flexion in both neutral rotation in supination. Conclusions: Performing a physical examination to assess the amount of instability of an ulnar collateral ligament injury did not create a Stener lesion if the exam was performed in a controlled, gentle manner with the thumb held without rotation. If the thumb is held in neutral rotation during the exam, an iatrogenic Stener lesion should not be created.

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“…The anatomy and biomechanics of the MCP joint as it pertains to these injuries is very well described in the literature. 2,3,6,7,11,12,14,16,21,23,25,29 Although there are a large variety of options for reconstruction of the UCL, there is also evidence to suggest that there is no difference in outcomes after acute ligament repair versus chronic ligament reconstruction. 31 In July, 2013, Samora et al published their results of a systematic review of the literature analyzing all cohorts of thumb UCL injuries with at least 2-year follow-up in the English literature.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Primary Repair of Chronic Thumb Ulnar Collateral Ligament Injuries

Christensen

Sarfani

Shin

2016

Hand (New York, N,Y.)

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The purpose of this study is to evaluate long-term outcomes of ligamentous repair rather than reconstruction for chronic thumb ulnar collateral ligament (UCL) injuries. Patients at least 15-years status-post repair of a chronic (greater than 6 weeks) UCL tear were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) pain scale, and study-specific questions. Twelve of 21 (57%) living patients were available for long-term, greater than 15-year follow-up (average 24.5 years, range 16.9-35.6). Eighty-eight percent of patients had some degree of osteoarthritis. Increased age at the time of injury and higher DASH scores were correlated with increased grades of the thumb metacarpophalangeal osteoarthritis. Delay to treatment and VAS pain scores had no correlation with radiographic findings. Repair of a chronic UCL injury with available local tissue appears to be a reasonable alternative to ligament reconstruction, resulting in durable long-term outcomes despite the majority of patients progressing to osteoarthritis.

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Anatomy of the Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

Cited by 47 publications

References 15 publications

Thumb collateral ligament injuries in the athlete

Thumb collateral ligament injuries in the athlete

Can Physical Examination Create a Stener Lesion?

Long-Term Outcomes of Primary Repair of Chronic Thumb Ulnar Collateral Ligament Injuries

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