Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy

Abstract

Purpose: This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. Methods: A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared. Results: Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). Conclusion: Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.

Surgical Treatment of a Neglected Thumb Volar Plate Injury in an 11-Year-Old Girl: A Case Report

“…MRI is also used to evaluate the injury and define its characteristics, including location and displacement [ 8 ]. However, according to a recent study in which MRI was used for the diagnosis of ligament injuries around the thumb MCP joint, researchers concluded that MRI is moderately effective, but is more sensitive in diagnosing acute injuries [ 2 ]. This was the finding in our case as well, as MRI was not sensitive enough to detect the volar plate rupture 2 months after the initial injury and a clinical diagnosis was made that led to surgery.…”

“…The thumb volar plate (also referred to as volar ligament, palmar plate, or palmar ligament) is a thick ligament on the underside of the metacarpophalangeal (MCP) joint of the thumb, which reinforces the joint capsule, enhances joint stability, and limits hyperextension [ 1 , 2 ]. The volar ligament is loose when the MCP joint is in flexion and tight when the MCP joint lies in extension.…”

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations

“…In addition, MRI has the utility of being able to identify concurrent palmar or other ligament injuries and bony contusions (25). For thumb MCP joint ligamentous injuries, 3.0 Tesla MRI has been shown to provide improved diagnostic accuracy compared with 1.5 Tesla with findings being consistent with arthroscopy in 76.9% and 47.1% of cases, respectively (37). MRI also showed better correspondence with arthroscopy findings in acute compared with chronic injuries.…”