Ulnar collateral ligament injuries of the first metacarpophalangeal joint: prevalence of associated injuries on radiographs and MRI

Sebastian Manneck,Anna Hirschmann,Filippo Del Grande

doi:10.1007/s00256-020-03575-w

Sebastian Manneck, Anna Hirschmann + Show 1 more

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https://doi.org/10.1007/s00256-020-03575-w

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Abstract

PurposeTo evaluate the prevalence of associated findings at the first metacarpophalangeal joint on radiographs and MRI following acute ulnar collateral ligament (UCL) injuries.Materials and methodsThis retrospective study included 25 patients with an injury of the UCL at MRI. Presence of associated injuries to the volar ligaments (checkrein and phalangoglenoid ligaments and volar plate) was assessed on radiographs and MRI independently by two musculoskeletal radiologists. Wilcoxon signed-rank test was used to compare frequencies of injuries between both modalities (p < 0.05). Interreader variability was calculated.ResultsComplete tears of the UCL (48%/60%, reader 1/2) were more common than partial tears (24%/16%) on MRI. Dislocation of the UCL ≥ 3 mm was detected in 40%/56% on MRI. UCL avulsion fractures were more frequently seen on MRI (28%) compared with radiographs (12%) for reader 1. Associated avulsion injuries of the phalangoglenoid ligament were evident in 12%/8% on radiographs and in 80%/76% on MRI. Almost all patients (100%/79%) with a dislocated UCL tear showed a concomitant volar ligament injury; and even two-thirds (66%/72%) of the non-displaced UCL tears had an injury to the volar ligaments. Interreader agreement was moderate to excellent (κ = 0.60–1.0).ConclusionUCL tears are often associated with volar ligament injuries, even in lesser degrees of an UCL injury.

Highlights

The ulnar collateral ligament (UCL) is the primary stabilizer of the first metacarpophalangeal (MCP) joint during valgus stress
At least 18 years old, with radiographs and MR images of one finger acquired between January 2014 and November 2018, were selected through a search of our Patients with evidence of sprain or rupture of the UCL on MR images, a time interval of up to 6 weeks between radiographs and magnetic resonance imaging (MRI), and imaging within 2 months of trauma were included in this study
MRIs were performed in patients with clinical suspicion for a dislocated tear of the UCL including Stener lesion and/or first MCP joint instability

Summary

Introduction

The ulnar collateral ligament (UCL) is the primary stabilizer of the first metacarpophalangeal (MCP) joint during valgus stress. Three components comprise the volar ligaments: the ulnar and radial checkrein ligaments, the ulnar and radial phalangoglenoid ligaments, and transverse intersesamoid fibers; the latter is known as the volar plate [5,6,7]. The checkrein ligaments insert proximally at the head of the metacarpal bone and embed the ulnar and Skeletal Radiol (2021) 50:505–513 radial sesamoid bones. The phalangoglenoid ligaments originate at the ulnar and radial sesamoids and traverse in an oblique fashion distally inserting at the outer base of the proximal phalanx. The volar plate connects both sesamoid bones and has a broad distal insertion at the center of the base of the proximal phalanx (Fig. 1) [6, 7]

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