Ultrasonographic stress testing of ulnar collateral ligament injuries of the thumb

Murphey, S L; Hashimoto, Beverly E.; Buckmiller, J; Kramer, Dawna J.; Wiitala, L.

doi:10.7863/jum.1997.16.3.201

Cited by 23 publications

(13 citation statements)

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“…9,10 Because of these problems, including the low sensitivity and specifity, we focused on the bony structures of the first MCP joint, such as the innominate tubercle of the first metacarpal and the base of the proximal phalanx, as the decisive landmarks, also described by others. Jones et al 10 and Murphey et al 17 reported that during stress testing the joint space is easy to identify and judged it in a qualitative manner. They recommended a quantitative study to evaluate joint space as a diagnostic tool for UCL rupture.…”

Section: Discussionmentioning

confidence: 98%

Ultrasonographic Stress Test of the Metacarpophalangeal Joint of the Thumb

Koslowsky¹,

Mader²,

Gausepohl³

et al. 2004

Clinical Orthopaedics and Related Research

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The purpose of this study was to evaluate functional ultrasound as a tool for detecting an ulnar collateral ligament injury of the thumb. The feasability of using ultrasound for imaging the thumb joint space was tested in a pilot study, using ultrasound and dissection in 14 cadaveric hand specimens. To test this method clinically, both metacarpophalangeal joints of the thumb in 461 healthy volunteers were examined using ultrasound (11 MHz) under radial stress. The distance between the innominate tubercle of the first metacarpal head to the proximal phalanx was measured. The mean distance between the first metacarpal head and the proximal phalanx (n = 461) was 4.5 mm (standard deviation, 0.65 mm) on the right side and 4.6 mm (standard deviation, 0.61 mm) on the left side. These data were compared with data of 25 patients with an operative diagnosis of rupture of the ulnar collateral ligament of the thumb. The difference in joint space between the injured and uninjured sides was 2.25 mm (standard deviation, 0.46 mm). The metacarpophalangeal joint space can be reproducibly detected on highfrequency ultrasound. An increased gap seen on ultrasound is indicative of a rupture of the ulnar collateral ligament of the thumb.Radial abduction forces to the extended thumb often result in a rupture of the ulnar collateral ligament (UCL) of the first metacarpophalangeal (MCP) joint. 2,12 This lesion is commonly called gamekeeper's thumb or skier's thumb. Whereas the term gamekeeper's thumb originates from the occupational injury observed in Scottish gamekeepers, 5 the term skier's thumb orginated from the German literature, because downhill skiers may experience sudden abduction of the thumb when the ski pole strap wraps around their thumb during a fall.In 1962 Stener was the first to describe the displacement of the completely ruptured UCL proximal to the aponeurosis of the adductor pollicis muscle. 25 In Stener's lesion, the displaced ligament cannot fall back spontaneously to its original position and operative treatment is necessary to prevent chronic joint instability and subsequent arthritic changes. For this reason a conclusive diagnosis of the pathologic features of the UCL is crucial to determine treatment.Evaluation of UCL injuries of the MCP joint of the thumb is difficult and relies on good clinical assessment and experience. 1,21 Traditionally, diagnosis is obtained by clinical examination supported by conventional radiography, arthrography, MRI, and ultrasound studies. 6,8,9,26 Numerous authors reported good results with ultrasonographic examination of the integrity of the UCL in gamekeeper's thumb, although substantial experience of the examiner and proper hardware to distinguish the soft tissue structures seen during examination are crucial. 5,19,20,23,24 The aim of the study was to search for an easy to learn and highly reproducible ultrasound technique in the diagnosis of an UCL injury. We focused on the distance of the joint space between the innominate tubercle of the first metacarpal and the base of the pro...

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Section: Discussionmentioning

confidence: 98%

Ultrasonographic Stress Test of the Metacarpophalangeal Joint of the Thumb

Koslowsky¹,

Mader²,

Gausepohl³

et al. 2004

Clinical Orthopaedics and Related Research

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“…Over the past few years, numerous studies on acute and chronic affections of the hand have been published, dealing in particular with the carpal tunnel syndrome, infections, tumors, and posttraumatic entities. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, we found no paper focused specifically on the sonoanatomy of the thenar region, including a description of the scan planes necessary for individual muscle assessment. Detailed knowl- However, the only aim of this study was to show the ability of ultrasonographic evaluation of all the components of the thenar compartment and to map out the origins and insertions of the specific muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, ultrasonography has been gaining a role of growing importance in the evaluation of soft tissues of the limbs. While a number of studies deal with anatomy and various pathologic conditions in the human hand, [1][2][3][4][5][6][7][8][9][10][11][12][13] none has concentrated on normal sonomorphology of the thenar muscles and on a standardized examination technique, including defined scan planes that guarantee complete sonomorphologic assessment of the thenar soft tissue.…”

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confidence: 99%

Sonographic evaluation of the thenar compartment musculature.

Grechenig

Peicha

Weiglein

et al. 2000

Journal of Ultrasound in Medicine

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“…Murphey et al [7] ont comparé la qualité du diagnostic par échographie à l'examen clinique chez 25 patients. Si le diagnostic de lésion ligamentaire ou non a pu être réalisé chez 25 patients à l'échographie contre 24 patients par l'examen clinique, deux lésions de Stener n'ont pas été retrouvées avec l'échographie et quatre par l'examen clinique.…”

Section: éChographieunclassified

“…• comparer des clichés en position forcée ; • mettre en évidence la lésion de Stener par échographie [4][5][6][7][8] ou imagerie par résonance magnétique (IRM) [9,10].…”

Section: Introductionunclassified