Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm

Abstract

The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.

Acute Thumb and Finger Instability

“…Despite that, outcomes are good especially for acute cases with good to excellent results in more than 90 % of cases as cited by Tang [ 48 ]. Problems arising are persistent pain, diffi culty with activities and weakness.…”

“…15.26 ) [ 47 ]. The ever-present sesamoids provide the much-needed lateral constraint, which, in the fi ngers is afforded by the fl exor sheath forming a pulley to prevent bowstringing [ 48 ]. The volar plate of the thumb MCPJ is similar to the fi nger PIP joints, although there are important differences.…”

“…The former are easier to use and reduce surgical time (and complications!) [ 48 ]. Placement of the anchor on the proximal phalanx is usually at a point 3 mm distal to the articular surface and 3 mm dorsal to the volar cortex [ 48 ].…”

“…[ 48 ]. Placement of the anchor on the proximal phalanx is usually at a point 3 mm distal to the articular surface and 3 mm dorsal to the volar cortex [ 48 ]. One limb of the suture is passed through the dorsal ligament then transversely to the volar side.…”

“…This greater occurrence of proximal avulsion could be because the footprint of the RCL is relatively bigger on the phalanx [ 48 ]. A radial-sided Stener lesion rarely occurs because the Abductor aponeurosis is more dorsal covering the entire RCL [ 61 ].…”