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Collateral Ligament Injury, Fingers and Thumb
Carol L. Andrews, MD; Donna G. Blankenbaker, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Deep transverse metacarpal ligament = intermetacarpal ligament; interglenoid ligament
            • Definitions

              • Dislocation: Complete dissociation of articular surfaces
              • Subluxation: Partial dissociation of articular surfaces
              • Sprain: Ligament injury
              • Types of collateral ligament injury
                • Gamekeeper's (skier's) thumb: Sprain or tear of ulnar collateral ligament (UCL) of 1st metacarpophalangeal (MCP) joint related to hyperabduction injury, ± avulsion fracture
                • Pseudo-boutonnière deformity: Extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx; results in proximal interphalangeal (PIP) joint flexion with distal interphalangeal (DIP) joint extension
                • Pseudo-boutonnière: Results from PIP hyperextension with volar plate injury and intact extensor tendon; may cause PIP flexion contracture over time
                • Stener lesion: Gamekeeper's thumb with retraction of torn UCL fibers with interposition of adductor pollicis aponeurosis between UCL and 1st metacarpal (MC)
                • "Swan neck" deformity: PIP extension with DIP flexion; results from volar plate injury at PIP or extensor tendon injury at DIP

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        PATHOLOGY

                        • Staging, Grading, & Classification

                          • Mechanisms of Injury

                            • Joint Specific

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Hirschmann A et al: MRI of the thumb: anatomy and spectrum of findings in asymptomatic volunteers. AJR Am J Roentgenol. 202(4):819-27, 2014
                                            2. Melville DM et al: Ultrasound of the thumb ulnar collateral ligament: technique and pathology. AJR Am J Roentgenol. 202(2):W168, 2014
                                            3. Milner CS et al: Gamekeeper's thumb: A treatment-oriented MRI classification. J Hand Surg Am. 40(1):90-5, 2014
                                            4. Arend CF et al: The role of US in the evaluation of clinically suspected ulnar collateral ligament injuries of the thumb: spectrum of findings and differential diagnosis. Acta Radiol. 55(7):814-23, 2014
                                            5. Martinoli C et al: Imaging finger joint instability with ultrasound. Semin Musculoskelet Radiol. 17(5):466-76, 2013
                                            6. Melville D et al: Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. Skeletal Radiol. 42(5):667-73, 2013
                                            7. Taylor KF et al: Radial collateral ligament injuries of the thumb metacarpophalangeal joint: epidemiology in a military population. J Hand Surg Am. 38(3):532-6, 2013
                                            8. Scalcione LR et al: The athlete's hand: ligament and tendon injury. Semin Musculoskelet Radiol. 16(4):338-49, 2012
                                            9. Tang P: Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. 19(5):287-96, 2011
                                            10. Doty JF et al: Radial collateral ligament injury of the thumb with a Stener-like lesion. Orthopedics. 33(12):925, 2010
                                            11. Ritting AW et al: Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20(2):106-12, 2010
                                            12. Carlsen BT et al: Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 34(5):945-52, 2009
                                            13. Ishizuki M et al: Stener-like lesions of collateral ligament ruptures of the metacarpophalangeal joint of the finger. J Orthop Sci. 14(2):150-4, 2009
                                            14. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                            15. Ebrahim FS et al: US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics. 26(4):1007-20, 2006
                                            16. Kijowski R et al: The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med. 25(3):569-90, viii, 2006
                                            17. Leggit JC et al: Acute finger injuries: part I. Tendons and ligaments. Am Fam Physician. 73(5):810-6, 2006
                                            18. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                            19. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                            20. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002
                                            21. Hinke DH et al: Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb). AJR Am J Roentgenol. 163(6):1431-4, 1994
                                            22. Eaton RG et al: Joint injuries and their sequelae. Clin Plast Surg. 3(1):85-98, 1976
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Deep transverse metacarpal ligament = intermetacarpal ligament; interglenoid ligament
                                                      • Definitions

                                                        • Dislocation: Complete dissociation of articular surfaces
                                                        • Subluxation: Partial dissociation of articular surfaces
                                                        • Sprain: Ligament injury
                                                        • Types of collateral ligament injury
                                                          • Gamekeeper's (skier's) thumb: Sprain or tear of ulnar collateral ligament (UCL) of 1st metacarpophalangeal (MCP) joint related to hyperabduction injury, ± avulsion fracture
                                                          • Pseudo-boutonnière deformity: Extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx; results in proximal interphalangeal (PIP) joint flexion with distal interphalangeal (DIP) joint extension
                                                          • Pseudo-boutonnière: Results from PIP hyperextension with volar plate injury and intact extensor tendon; may cause PIP flexion contracture over time
                                                          • Stener lesion: Gamekeeper's thumb with retraction of torn UCL fibers with interposition of adductor pollicis aponeurosis between UCL and 1st metacarpal (MC)
                                                          • "Swan neck" deformity: PIP extension with DIP flexion; results from volar plate injury at PIP or extensor tendon injury at DIP

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  PATHOLOGY

                                                                  • Staging, Grading, & Classification

                                                                    • Mechanisms of Injury

                                                                      • Joint Specific

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Hirschmann A et al: MRI of the thumb: anatomy and spectrum of findings in asymptomatic volunteers. AJR Am J Roentgenol. 202(4):819-27, 2014
                                                                                      2. Melville DM et al: Ultrasound of the thumb ulnar collateral ligament: technique and pathology. AJR Am J Roentgenol. 202(2):W168, 2014
                                                                                      3. Milner CS et al: Gamekeeper's thumb: A treatment-oriented MRI classification. J Hand Surg Am. 40(1):90-5, 2014
                                                                                      4. Arend CF et al: The role of US in the evaluation of clinically suspected ulnar collateral ligament injuries of the thumb: spectrum of findings and differential diagnosis. Acta Radiol. 55(7):814-23, 2014
                                                                                      5. Martinoli C et al: Imaging finger joint instability with ultrasound. Semin Musculoskelet Radiol. 17(5):466-76, 2013
                                                                                      6. Melville D et al: Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. Skeletal Radiol. 42(5):667-73, 2013
                                                                                      7. Taylor KF et al: Radial collateral ligament injuries of the thumb metacarpophalangeal joint: epidemiology in a military population. J Hand Surg Am. 38(3):532-6, 2013
                                                                                      8. Scalcione LR et al: The athlete's hand: ligament and tendon injury. Semin Musculoskelet Radiol. 16(4):338-49, 2012
                                                                                      9. Tang P: Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. 19(5):287-96, 2011
                                                                                      10. Doty JF et al: Radial collateral ligament injury of the thumb with a Stener-like lesion. Orthopedics. 33(12):925, 2010
                                                                                      11. Ritting AW et al: Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20(2):106-12, 2010
                                                                                      12. Carlsen BT et al: Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 34(5):945-52, 2009
                                                                                      13. Ishizuki M et al: Stener-like lesions of collateral ligament ruptures of the metacarpophalangeal joint of the finger. J Orthop Sci. 14(2):150-4, 2009
                                                                                      14. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                                                                      15. Ebrahim FS et al: US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics. 26(4):1007-20, 2006
                                                                                      16. Kijowski R et al: The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med. 25(3):569-90, viii, 2006
                                                                                      17. Leggit JC et al: Acute finger injuries: part I. Tendons and ligaments. Am Fam Physician. 73(5):810-6, 2006
                                                                                      18. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                                                                      19. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                                                                      20. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002
                                                                                      21. Hinke DH et al: Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb). AJR Am J Roentgenol. 163(6):1431-4, 1994
                                                                                      22. Eaton RG et al: Joint injuries and their sequelae. Clin Plast Surg. 3(1):85-98, 1976