Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress.

Abstract

Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.

The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria

“…28 Studies using MRI to detect UCL injuries found that MRI yielded sensitivity of 96% to 100% and specificity of 94% to 100% for the detection of Stener lesions. 23,28 The accuracy of MRI has led to the development of a new classification guide for UCL management based on MRI scans displaying distance of UCL displacement in millimeters. 18 A recent treatment-oriented classification proposed by Milner 18 suggests surgery for all ruptured ligaments demonstrating displacement of 3 mm or greater (type 3) as well as those appearing to have a Stener lesion (type 4).…”

MRI of the Stener lesion

“…Recently, it has been reported that MRI may serve as a useful diagnostic tool for the evaluation of UCL tears. Results of 100% sensitivity and 94% specificity in depicting Stener lesions have been reported in a cadaveric study [9]. The present study was designed to assess the value of MRI in the detection of Stener lesions in the cadaveric model.…”

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

“…Thus, the tom ligament can become trapped by the aponeurosis and folded over to point proximally, when the abduction force is released (Stener 1962). 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.…”

“…(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…”