Rupture and displacement of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Preoperative diagnosis.

Abstract

The evaluation and treatment of injuries of the ulnar collateral ligament of the metacarpopha. langeal joint of the thumb remain controversial. In a retrospective study that was done to assess our ability to determine whether displacement of the ligament (a Stener lesion) was present, we reviewed our accumulated[ experience with patients who had an injury of this lig.. ament who were treated surgically between 1972 and 1984. Since our method of evaluation changed in 1977, we compared the preoperative and operative diagnoses in the twenty patients who were treated surgically from 1972 through 1976 with those in the twenty patients who were so treated from 1977 through 1984. Considering all forty patients who were treated operatively, sixteen (40 per cent) had a typical Stener lesion, and in two others (5 per cent) the ulnar collateral ligament was rolled up ~on itself and lying beneath the adductor aponeurosis. From 1972 through 1976, stability was tested with the metacarpophalangeal joint in complete extension or in varying amounts of flexion. Of the twenty thumbs that were evaluated by this technique and.were treated surgically, 20 per cent had a Stener lesion. From 1977 through 1984, stability was tested with the joint in full flexion because of the findings in anatomical stfidies that were completed in 1977; the incidence of a Stener lesion in the twenty thumbs that were treated by repair or reattachment of the ligament during this time was 70 per cent. We believe that when no fracture is present, a proper physical examination of an injured thumb is sufficient to determine the degree of instability of the ulnar collateral ligament, and that a five-stage grading system of injuries that appear to involve the ulnar side of the metacarpophalangeal joint of the thumb is helpful in separating them into operative and non-operative groups. * No benefits in any form have been received or Will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Injury to the Ulnar Collateral Ligament of the Thumb

“…There is also a rare variation of this injury where the ulnar collateral ligament remains intact, and there is an avulsion fracture involving the volar plate [25,29].…”

Ulnar collateral ligament injuries of the thumb: Dislocation caused by stress radiography in 2 cases

“…Closed treatment is adequate for nondisplaced ruptures (Newland 1992, Spaeth et at. 1993) whereas for ruptures with displacement superficial to the adductor aponeurosis, surgical treatment is advocated (Louis et al 1986, Wilhelm et al 1989. Physical examination can hardly distinguish between a nondisplaced tear and a retracted ligament but stress radiography has been suggested to be of value (ref.)…”

“…(Abrahamsson et a1.1990). However, Louis et al (1986) and Spaeth et al (1993) have proposed that displacement of a ruptured but nondisplaced ligament may occur during stability testing. Bronstein et al…”

Can Physical Examination Create a Stener Lesion?

“…The conclusions vary, but angulation of 30-45°, or a 10-15° difference in laxity when compared to the contralateral uninjured side, generally suggests a complete tear of both components of the UCL. [1][2][3][4][5][6] Treatment guidelines for thumb UCL injuries are based on the severity of injury. Partial tears of the proper UCL (pUCL) or the accessory UCL (aUCL), or complete tears with minimal displacement, can be treated effectively with immobilization.…”

“…Complete tears respond more predictably to operative repair. [1][2][3][4][5] Stener, in his original paper, described his eponymous lesion as complete rupture of the UCL and interposition of the adductor aponeurosis between the distally avulsed UCL and its…”