Radiographs of the thumb are often of normal appearance. Because the LCL has an important role in supporting the elbow, injury can lead to elbow instability. This injury can be functionally disabling if not properly diagnosed and treated appropriately. When you look for the radial collateral ligament, first try to identify the common extensor tendon, because right underneath it you will find the radial collateral ligament (yellow arrow). Summary. Classically, this could be due to a ski pole during a fall. Stretch injury involving the radial-sided pulley at the IP joint (short-axis 401 image 1) Radial and ulnar collateral ligaments at the IP joint of the thumb are seen in obliquity with signal hyperintensity of the radial-sided ligament insertion. Post By: Jeff Stotts Date: January 23, 2015 Category: Break Down, NBA LaMarcus Aldridge is expected to miss at least the next six weeks after a second MRI on his injured thumb revealed a torn radial collateral ligament … 10.1055/b-0040-177478 63 Finger Metacarpophalangeal Joint Collateral Ligament RepairGregory G. Gallant Abstract Injuries to the collateral ligaments of the fingers are less common than those sustained in the thumb. Coronal (a) and axial (b) T2-weighted MR images show a complete proximal tear of the radial collateral ligament (arrows). Thumb Collateral Ligament Injuries, most commonly ulnar collateral (UCL), are athletic injuries that lead to a decrease in effective thumb pinch and grasp. Treatment is nonoperative with buddy splinting with the exception of radial collateral injury to the index finger which requires surgical repair. Rupture of the collateral ligaments of the thumb metacarpophalangeal (MCP) joint is a common injury. In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. Mild thickening and irregularity of radial collateral ligament are seen – likely sequelae of old sprain / partial tear. The thumb metacarpophalangeal joint contains two important ligaments: the ulnar collateral ligament, which is on the pinky side of the thumb, and the radial collateral ligament, which is on the free side of the thumb. The collateral ligaments of the thumb MCPJ are composed of the proper collateral component, which inserts into the volo-ulnar base of the proximal phalanx, and the accessory collateral component, which locates volar to the proper collateral component and inserts into the volar plate. Mechanism and pathophysiology. Because injuries of the LUCL most commonly occur as avulsions from the distal humerus, 25 an understanding of the anatomy and normal MRI appearance, focusing on the ligament origin enables a more precise assessment of underlying lesions of the lateral collateral ligament complex and the overlying tendinous structures. Radial collateral ligament injuries occur as a result of a forced adduction moment on the MCP joint of the thumb, which may occur from a fall on the radial aspect of the thumb and hand or during sports when a ball or player strikes the thumb. grade 1: (minor sprain) high signal is seen medial (superficial) to the ligament, which looks normal grade 2: (severe sprain or partial tear) high signal is seen medial to the ligament, with high signal or partial disruption of the ligament This is opposed to horizontal and vertical meniscus tears, which make up the other planes of meniscal tears. Lesions of the thumb MCP are common and vary in severity, ranging from mild sprain to dislocation. The most common injury to a collateral ligament at the MCP joint of the thumb is a skiers’ thumb. Gamekeeper's thumb is an avulsion or rupture of the ulnar collateral ligament of the thumb. Crossref, Medline, Google Scholar; 25. Diagnosis is made clinically and MRI may be required for confirmation. 12C —55-year-old man with clinically suspected thumb radial collateral ligament (RCL) tear after sledding injury 1 month earlier. However, on occasion they can show a dorso-radial displacement of the metacarpal. This ligament can become sprained or torn as a result of a sports injury. The US characteristics of tears are similar to those of UCL tears with the exception of complications such as Stener lesion, which do not occur given anatomic differences. Radial tears extend across the short axis of a meniscus perpendicularly to the tibial plateau and will extend in a radial orientation from the central intercondylar region. Chronic partial tear of the ulnar collateral ligament first MCP articulation non-Stener type. Campbell coined the term “Gamekeeper’s thumb”2, having noticed this injury in The extensor mechanism, flexor ten-dons, and retinacular ligaments play a major role in dynamic stability. The ligaments and pulleys of the thumb show considerable variability on MRI in healthy volunteers. been assessed in healthy volunteers on MRI. MRI criteria for diagnosis of a ligament strain include a continuous ligament with surrounding edema in … 30/06/2013 4 Acute Injuries! X-rays can be helpful in the workup of this injury and MRI can be… It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Thumb metacarpophalangeal collateral ligament injuries are common in athletes and occur via forced abduction or hyperextension. Plast Reconstr Surg 2006;117(2):491–496. The proper collateral ligaments are taut during flexion, whereas the accessory collateral ligaments are taut during extension. Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). cially the collateral ligaments and the volar plate (Fig 1) (15). The recent case had a complex ligaments injury of the thumb metacarpophalangeal joint including UCL, RCL, and A1 annular pulley in the background of multidirectional thumb trauma. The tear appears as a complete interruption of the ligamentous fibers with intra- and periligamentous high signal intensity secondary to edema, hemorrhage, and probable extravasation of intraarticular fluid. Skier’s thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 3-8 This injury has been referred to as “reverse gamekeeper’s thumb.” 9 Although some similarities exist in terms of examination and management, injuries of the UCL and RCL are not mirror images of each other, and each type deserves specific and special attention. This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. Transection is an alternative term for a complete radial tear. As a result, injuries to the ulnar collateral ligament in the professional baseball pitcher are quite common. This is a tear of the ulnar collateral ligament (UCL) which occurs when the thumb is forcefully pushed into radial deviation. RCL injury is less common than UCL injury and constitutes 10% to 42% of collateral ligament injuries. The thumb MCP is a diarthrodial ginglymoid joint that allows motion primarily in flexion and extension. Medial collateral ligament (MCL) injuries are graded into three groups on MRI, much in the same way as many other ligaments:. Stress radiographs may show displacement of the base of the metacarpal, [], which correlates with joint laxity.MRI has been recommended to image the beak ligament [].Arthroscopy of the CMCJ can show ligament damage and also, importantly, assess … Collateral ligament injuries cause in - stability of thumb grip and pinch; most fre-quently, the ulnar collateral ligament of the The ulnar collateral ligament of the metacarpophalangeal joint is typically less than 3 mm thick, and the radial collateral ligament is less than 2 mm thick. Key words: Gamekeeper’s thumb; Skier’s thumb; Thumb injury; Ulnar collateral ligament Introduction C ollateral ligament injuries have been noted in all digits of the hand, but occur more commonly in the ulnar and radial collateral ligaments of the thumb1. Ossification within the radial collateral ligament (arrowhead) denotes a remote injury. Management primarily depends on the grade of ligamentous injury and the presence of a Stener lesion or large avulsion fracture. Radial collateral ligament tears are less common in the thumb than in the fingers. RCL Injury. Diagnosis. In most cases, a physician will diagnose an ulnar collateral ligament injury using a patient's medical history and a physical examination that includes a valgus stress test. The valgus stress test is performed on both arms and a positive test is indicated by pain on the affected arm that is not present on the uninvolved side. The ligaments of the thumb carpometacarpal joint (a) palmar aspect: note the dorsal radial ligament (DRL) reinforced by the abductor pollicis longus (APL) tendon sheath (shaded). Repetitive injury of the ulnar collateral ligament of the thumb metacarpophalangeal joint caused when the gamekeeper broke the neck of game, using their thumb, index finger and the ground, leading to eventual tear of the ligament. Understanding Lamarcus Aldridge’s Radial Collateral Ligament Tear. The Lateral collateral ligament of the elbow (LCL) is sometimes also called the radial collateral ligament (RCL). The collateral ligament com-plex consists of the collateral ligament proper and an accessory collateral ligament. A full-thickness synovial recess at the base of the dorsal plate of the metacarpophalangeal joint was seen in … Secondary signs of ligament tear that may be present include adjacent soft tissue hematoma and subcortical bone contusion on one or both sides of the CMC joint. The ulnar collateral ligament of the metacarpophalangeal joint is typically striated and less than 3 mm thick. These collateral ligaments are critical for the stability of the thumb and for pinch and grip activities of daily living. Radial Collateral ligament! An ulnar collateral ligament injury most often occurs as a result of sports injuries . Athletes who are skiers and soccer players often sustain this injury. An ulnar collateral ligament injury can also occur as the result of a fall or other trauma . • Skier’s thumb! Injuries to the other side of the thumb, the radial collateral ligament (RCL) … Gradient coronal MR image of the third ray demonstrates an acute, partial tear of the ulnar collateral ligament of the PIP (curved arrow) with edema within the ligament. (figure 2C) [14] [16] [4] Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. High-grade partial tear of ulnar collateral ligament of 1 st metacarpophalangeal joint at proximal phalanx with cortical irregularity at proximal phalanx insertion. Lateral Collateral (Radial Collateral) Ligament Injuries. Sprains can vary in severity from partial tears of the ligament to complete tears. Radial collateral ligament injuries of the thumb. Prevalence of this injury during skiing varies from 7% up to as high as 32% of all skiing injuries and is the most frequent injury of the upper extremity that skiers experience. • Volar plate tear! As you go more posteriorly you will see the LUCL - the lateral ulnar collateral ligament, which sweeps behind the radial head (white arrows). Injuries to the ulnar collateral ligament of the thumb are the second most common ski-related injury. Patients with chronic injury may reveal ligament laxity/redundancy, ligament thickening and/or a ganglion cyst arising from the AOL insertion on the thumb metacarpal. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier’s thumb. Surgeons should consider the athlete’s position, hand dominance, duration of season remaining, and goals. Figure 18.20 Collateral ligament injury of the proximal interphalangeal (PIP). MCP collateral ligament sprain is most commonly an acute injury related to trauma. Horch RE, Dragu A, Polykandriotis E, Kneser U. The most common site of injury in the thumb is the ulnar collateral ligament (UCL) of the metacarpal-phalangeal joint. • Radial collateral tear! J Hand Surg Am 2008;33(5):760–770. The collateral ligament complex is the main stabilizer of the metacarpophalangeal and the interphalangeal joints of the thumb [13–18].

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