Injury to Ulnar Collateral Ligament of Thumb

Abstract

Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far.

Sonographic diagnosis of an acute Stener lesion: a case report

“…Tears of the UCL of the thumb may be partial or complete, displaced or non-displaced, and may include an avulsed fragment, usually from the proximal phalanx [3]. The Stener lesion can be simply defined as a displaced, full-thickness tear of the UCL at the first MCPJ.…”

“…1c, 3b, Online Resource 2) [11,12]. In addition to these positive aspects, US is more time and cost effective and less invasive when compared to MR arthrography [3,9]. Another advantage is its capability to quickly image the contralateral (uninjured) side for comparison [6].…”

“…Injury to the UCL of the thumb is common, estimated as high as 200,000 cases annually [2]. Varying degrees of ligamentous tears may be present, ranging from mild sprain to complete rupture [3]. Stener further described full-thickness tears as being non-displaced or displaced in relation to the aponeurosis of the adductor pollicis muscle, with the latter being given the eponymous term ''Stener lesion'' [4].…”

Emergency and Trauma of Hand and Wrist

“…9,111 Trauma mechanism mainly includes abduction and radial directed forces, mostly in skiers and other sports participants (therefore often referred to as gamekeeper's or skier's thumb). 111,128 Diagnosis is challenging, and assessment should include evaluation of associated avulsion fractures of the ulnar side of the base of the proximal phalanx. Radial deviation or slight subluxation is also associated with UCL injury.…”

The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Using Extensor Pollicis Brevis: Surgical Technique

“…Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force. 5,6 Usually, a full or partially injured thumb ligament is recognized by clinical examination of the thumb. However, sometimes a complete injury can be difficult to detect 7 because the adductor muscle aponeurosis of the thumb can be trapped between the MCP joint and the ligament, which can make the joint seem stable upon clinical examination.…”