Simultaneous combined complete tear of radial and ulnar collateral ligaments of thumb in an adolescent

Abstract

Isolated tear of collateral ligaments of thumb are common but combined injuries of both radial and ulnar collateral ligaments are rare. These cases are reported in athletes involved in high-impact sports. Here, we report a case of a 15-year-old boy with pain at base of the thumb and instability following low-impact sporting activity. On subsequent clinicoradiological assessment, simultaneous combined complete tear of both radial and ulnar collateral ligaments of the thumb was noted. Delayed primary repair of both collateral ligaments was done. This case highlights the rarity of this type of injury in an adolescent and also the use of appropriate clinical tests and imaging modalities for early diagnosis of such injuries. Restoration of joint stability as early as possible either by repair or reconstruction of ligaments needs to be considered to prevent secondary osteoarthritis of metacarpophalangeal joint.

Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint

“…Combined collateral ligament injuries are rare, with most reported cases occurring in athletes participating in high-impact sports with a complex mechanism including MCP joint rotation, axial loading, and hyperextension combined with an applied adduction/abduction force (Fig. 13) (27) . These injuries are often associated with volar plate or dorsal capsular injuries (19) .…”

Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions

“…Simultaneous RCL and UCL injuries that occur secondary to one single traumatic event are rare, but they represent an interesting subset of lesions. 39,40 The presumed mechanism of injury is still speculative but likely includes axial loading and alternating and opposed shear forces (►Fig. 5).…”

“…40 RCL tears can be imaged by either US or MRI; however, the imaging literature of the RCL is limited. 20,27,39 In our experience, the advantages of US for ligamentous assessment in general relates to the fact that gentle stress can be applied under US guidance to show how fluid fills a complete tear but does not fill an in situ tear. This subtle stress maneuver provides a diagnostic advantage that offsets the lack of contrast resolution in US as compared with MRI.…”

Persistent Thumb Metacarpophalangeal Joint Instability after Trivial Trauma

“…1 Combined ligamentous injuries were also reported by Bhat et al, in which J Hand Microsurg:2020;12:133-134 Letter to the Editor an adolescent sustained two separate injuries while playing volleyball and badminton. 2 The patient was initially managed conservatively; however, after 2 months without symptomatic improvement, delayed primary repair was chosen over reconstruction; the collateral ligaments were anatomically repaired using 1.8 mm suture anchors. 2 The literature is limited regarding this rare injury; these two references do not describe an algorithm for the management of combined injuries.…”

“…2 The patient was initially managed conservatively; however, after 2 months without symptomatic improvement, delayed primary repair was chosen over reconstruction; the collateral ligaments were anatomically repaired using 1.8 mm suture anchors. 2 The literature is limited regarding this rare injury; these two references do not describe an algorithm for the management of combined injuries. To our knowledge, our case report is the first of a combined thumb MCP collateral ligament injury due to an isolated traumatic event.…”