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Collateral Ligament Injury, Fingers and Thumb
Kambiz Motamedi, MD, FACR; Carol L. Andrews, MD; Kirkland W. Davis, MD, FACR
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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 thumb (1st) MCP joint related to hyperabduction injury, ± avulsion fracture
                • Stener lesion: gamekeeper's thumb with retraction of torn UCL fibers & interposition of adductor pollicis aponeurosis between UCL & 1st metacarpal (MC)
                • Pseudoboutonnière deformity: extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx; results in PIP joint flexion with DIP joint extension
                • Pseudoboutonnière: results from PIP hyperextension with volar plate (VP) injury & intact extensor tendon; may cause PIP flexion contracture over time
                • Swan-neck deformity: PIP extension with DIP flexion; results from VP injury at PIP or extensor tendon injury at DIP
              • VP relation to collateral ligaments
                • Finger PIP & DIP
                  • Proper collateral ligaments: insert on volar base of middle or distal phalanx, respectively
                  • Accessory collateral ligaments: insert into VP, fan-shaped in PIP

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          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. Petchprapa CN et al: MRI of the fingers: an update. AJR Am J Roentgenol. 213(3):534-48, 2019
                                              2. Cockenpot E et al: Imaging of sports-related hand and wrist injuries: sports imaging series. Radiology. 279(3):674-92, 2016
                                              3. 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
                                              4. 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
                                              5. Melville DM et al: Ultrasound of the thumb ulnar collateral ligament: technique and pathology. AJR Am J Roentgenol. 202(2):W168, 2014
                                              6. Milner CS et al: Gamekeeper's thumb: a treatment-oriented MRI classification. J Hand Surg Am. 40(1):90-5, 2014
                                              7. Martinoli C et al: Imaging finger joint instability with ultrasound. Semin Musculoskelet Radiol. 17(5):466-76, 2013
                                              8. 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
                                              9. 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
                                              10. Scalcione LR et al: The athlete's hand: ligament and tendon injury. Semin Musculoskelet Radiol. 16(4):338-49, 2012
                                              11. Tang P: Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. 19(5):287-96, 2011
                                              12. Doty JF et al: Radial collateral ligament injury of the thumb with a Stener-like lesion. Orthopedics. 33(12):925, 2010
                                              13. Ritting AW et al: Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20(2):106-12, 2010
                                              14. Carlsen BT et al: Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 34(5):945-52, 2009
                                              15. 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
                                              16. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                              17. 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
                                              18. 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
                                              19. Leggit JC et al: Acute finger injuries: part I. Tendons and ligaments. Am Fam Physician. 73(5):810-6, 2006
                                              20. 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
                                              21. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                              22. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002
                                              23. 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
                                              24. 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 thumb (1st) MCP joint related to hyperabduction injury, ± avulsion fracture
                                                            • Stener lesion: gamekeeper's thumb with retraction of torn UCL fibers & interposition of adductor pollicis aponeurosis between UCL & 1st metacarpal (MC)
                                                            • Pseudoboutonnière deformity: extensor tendon central slip injury at or near insertion on middle phalanx, ± avulsion fracture of dorsal base of middle phalanx; results in PIP joint flexion with DIP joint extension
                                                            • Pseudoboutonnière: results from PIP hyperextension with volar plate (VP) injury & intact extensor tendon; may cause PIP flexion contracture over time
                                                            • Swan-neck deformity: PIP extension with DIP flexion; results from VP injury at PIP or extensor tendon injury at DIP
                                                          • VP relation to collateral ligaments
                                                            • Finger PIP & DIP
                                                              • Proper collateral ligaments: insert on volar base of middle or distal phalanx, respectively
                                                              • Accessory collateral ligaments: insert into VP, fan-shaped in PIP

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      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. Petchprapa CN et al: MRI of the fingers: an update. AJR Am J Roentgenol. 213(3):534-48, 2019
                                                                                          2. Cockenpot E et al: Imaging of sports-related hand and wrist injuries: sports imaging series. Radiology. 279(3):674-92, 2016
                                                                                          3. 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
                                                                                          4. 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
                                                                                          5. Melville DM et al: Ultrasound of the thumb ulnar collateral ligament: technique and pathology. AJR Am J Roentgenol. 202(2):W168, 2014
                                                                                          6. Milner CS et al: Gamekeeper's thumb: a treatment-oriented MRI classification. J Hand Surg Am. 40(1):90-5, 2014
                                                                                          7. Martinoli C et al: Imaging finger joint instability with ultrasound. Semin Musculoskelet Radiol. 17(5):466-76, 2013
                                                                                          8. 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
                                                                                          9. 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
                                                                                          10. Scalcione LR et al: The athlete's hand: ligament and tendon injury. Semin Musculoskelet Radiol. 16(4):338-49, 2012
                                                                                          11. Tang P: Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. 19(5):287-96, 2011
                                                                                          12. Doty JF et al: Radial collateral ligament injury of the thumb with a Stener-like lesion. Orthopedics. 33(12):925, 2010
                                                                                          13. Ritting AW et al: Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20(2):106-12, 2010
                                                                                          14. Carlsen BT et al: Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am. 34(5):945-52, 2009
                                                                                          15. 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
                                                                                          16. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                                                                          17. 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
                                                                                          18. 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
                                                                                          19. Leggit JC et al: Acute finger injuries: part I. Tendons and ligaments. Am Fam Physician. 73(5):810-6, 2006
                                                                                          20. 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
                                                                                          21. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                                                                          22. Clavero JA et al: MR imaging of ligament and tendon injuries of the fingers. Radiographics. 22(2):237-56, 2002
                                                                                          23. 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
                                                                                          24. Eaton RG et al: Joint injuries and their sequelae. Clin Plast Surg. 3(1):85-98, 1976