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

Rashidi, Ali; Haj‐Mirzaian, Arya; Dalili, Danoob; Fritz, Jan

doi:10.1007/s00330-020-07666-z

Cited by 12 publications

(12 citation statements)

References 40 publications

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“…8e15 Of these, magnetic resonance imaging is the only modality found to be 99% sensitive and 100% specific in determining the correct diagnosis. 10 However, among the abovementioned studies, the specific rupture site location has often not been reported.…”

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confidence: 99%

“…Radiographs, magnetic resonance imaging, and ultrasound are imaging modalities that have been widely used to help establish a diagnosis. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 Of these, magnetic resonance imaging is the only modality found to be 99% sensitive and 100% specific in determining the correct diagnosis. 10 However, among the abovementioned studies, the specific rupture site location has often not been reported.…”

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confidence: 99%

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Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

Morales-Restrepo

Bhogal

Fowler

2021

Journal of Hand Surgery Global Online

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Thumb metacarpophalangeal collateral ligament injuries occur in 50 per 100,000 people. The most frequent rupture site locations that are often cited are the thumb ulnar collateral ligament (UCL) occurring distally from the proximal phalanx and the radial collateral ligament (RCL) occurring proximally from the metacarpal head. 2,16 In this study, we report the frequency of the rupture site location of both thumb UCL and RCL injuries. Methods: A retrospective analysis of 1,004 consecutive finger collateral ligament surgeries performed at a single academic institution over 17 years was conducted. The inclusion criteria were any patient who underwent either a thumb UCL or RCL surgical repair. Patients were excluded if the rupture etiology was secondary to a laceration or a congenital or chronic deformity. Descriptive statistics were presented. Results: Three hundred forty-seven patients were included in this study, including 288 thumb UCL injuries and 59 thumb RCL injuries. The rupture site location for the thumb UCL was proximal in 5.9% (n ¼ 17) of the cases, distal in 92.7% (n ¼ 267), and midsubstance in 1.4% (n ¼ 4). Fifty-three (18.4%) Stener lesions were noted. The rupture site location for the thumb RCL was proximal in 69.5% (n ¼ 41) of the cases, distal in 25.4% (n ¼ 15), and midsubstance in 5.1% (n ¼ 3). Conclusions: In thumb UCL ruptures, the rupture site occurred most often at the proximal phalanx, whereas RCL injuries occurred most often at the metacarpal head. Overall, there was greater heterogeneity of RCL rupture site location frequency. Careful surgical exposure should be performed when repairing either the UCL or RCL. Further studies will determine if differences in rupture site location portend a difference in prognosis. Type of study/level of evidence: Prognostic III.

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confidence: 99%

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confidence: 99%

Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

Morales-Restrepo

Bhogal

Fowler

2021

Journal of Hand Surgery Global Online

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“…Ligament injuries of MCP joints of lesser digits have been less frequently reported, and studies have shown the unsuccess of MRI in demonstrating lesser digits MCP joint collateral ligament injuries [2]. However, MRI and ultrasound (USG) accuracy was found to be relatively high in the evaluation of thumb MCP pathologies [14][15][16][17]. In contrast to the many positive studies that have reported the accuracy of MRI in detecting thumb MCP joint collateral ligament injuries, there are very few publications on the characteristics of MRI for PIP joints of the lesser digits.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits’ Proximal Interphalangeal Joints

Şahin¹

2022

Cureus

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BackgroundCollateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits. MethodsA retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. ResultsIn digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p<0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727). ConclusionThis study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.

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“…Finally, for MRI, sensitivity was 99% and specificity was 100%. 15 Because the finding of a tear on MRI does not necessarily correlate with clinical instability, the practitioner should rely heavily on the physical examination in diagnosing UCL tears and guiding management.…”

Section: Diagnosismentioning

confidence: 99%

Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation

Chang¹,

Merkow²,

Bookman³

et al. 2023

J Am Acad Orthop Surg

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First described in 1955 as "gamekeeper's thumb," injuries to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint are common and can cause pain and instability, especially during key pinch and grasp. Although primarily diagnosed on physical examination, stress radiographs, ultrasonography, and magnetic resonance imaging can be used to diagnose UCL injuries and distinguish partial from complete tears. If complete rupture occurs, the adductor aponeurosis can become interposed between the retracted UCL stump and its insertion on the proximal phalanx, known as a "Stener lesion." When instability persists after a trial of nonsurgical management or in the setting of complete rupture, there are various methods of repair or reconstruction. Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament. Recently, suture tape augmentation has been used for the repair or reconstruction with excellent short-term results and earlier return to function, although there is a paucity of literature on longer term outcomes. The various methods of surgical treatment yield excellent outcomes with a low incidence of complications.

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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

Cited by 12 publications

References 40 publications

Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits’ Proximal Interphalangeal Joints

Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation

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