US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis

Abstract

The thumb is a central component supporting the intricate movements of the hand. Patients with acute thumb pain, particularly after trauma, require prompt evaluation of structural integrity, thus avoiding long-term morbidity such as instability, chronic pain, and osteoarthritis. Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate. US is more dynamic and less time-consuming and may be easier to perform. Furthermore, other disorders such as tenosynovitis, tendon tears, and articular pathologic conditions can involve the thumb and thenar region and may also be diagnosed with US. In this context, US is an underused tool because it is potentially an adjunct to the clinical examination in the appropriate setting. A sound knowledge of the regional anatomy and basic training in the principles of US should equip the imager with the skills necessary to evaluate the UCL of the thumb and its surrounding structures.

Fracture of the sesamoid bones of the thumb associated with volar plate injury: ultrasound diagnosis

“…Intrasubstance tear of the VP can occur [8]: in this latter case arthrography can demonstrate contrast leakage from the volar aspect of the joint [7]. MR imaging of the fingers has been employed in the pathology of the VP to evaluate the state of the plate and to precisely identify its location and displacement [5,12]. US might be an excellent imaging technique for the diagnosis of these injuries [5,9,10,13].…”

“…MR imaging of the fingers has been employed in the pathology of the VP to evaluate the state of the plate and to precisely identify its location and displacement [5,12]. US might be an excellent imaging technique for the diagnosis of these injuries [5,9,10,13]. At US, in sagittal scan over the palmar aspect of the MCP joint of the thumb, a normal VP appears as a triangular echogenic and homogeneous structure deep to the flexor pollicis longus tendon [5,10].…”

“…US might be an excellent imaging technique for the diagnosis of these injuries [5,9,10,13]. At US, in sagittal scan over the palmar aspect of the MCP joint of the thumb, a normal VP appears as a triangular echogenic and homogeneous structure deep to the flexor pollicis longus tendon [5,10].…”

“…Detailed knowledge of normal anatomy and anatomic variants is essential, as well as the skill to correlate imaging findings with clinical data. Higher frequencies transducer (17 or 18 MHz) could be helpful in the sonographic evaluation of the hand, but in our case diagnosis was possible with a 12-MHz transducer [5,6,[8][9][10].…”

“…The ulnar collateral ligament (UCL), which is frequently involved in case of MCP joint trauma and mainly in valgus stress-the so-called gamekeeper's thumb-was regular [5,6].…”