Sage Journals: Discover world-class research

Abstract

Background

Diagnostic stress testing of ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal (MCP) joint is pivotal to determining treatment. Comparison to the uninjured extremity and fluoroscopy-assisted examination are readily available modalities in the assessment of these patients, with 5–10° differences impacting treatment. Comparative examination, however, assumes that both extremities are normally equal, which has never been verified experimentally. Comparison of clinical and fluoroscopic examination has also never been scrutinized.

Method

One hundred asymptomatic participants underwent both fluoroscopic and traditional stress examinations to determine maximum passive radial deviation at neutral MCP flexion.

Results

Absolute clinical vs. fluoroscopic differences demonstrated a significant difference of 5.6° (SD 5.1°). Absolute variability between left-to-right measurements was 4.5° (SD 4.1°) and increased significantly as baseline stress deviation increased (R = 0.43; p < 0.001). Left-to-right difference exhibited no correlation to age, gender, or BMI.

Conclusions

The current investigation demonstrates right–left differences and differences between clinical and fluoroscopic testing of which practitioners should be aware when making treatment decisions for UCL injury of the thumb MCP joint.

Keywords

Thumb metacarpophalangeal joint Thumb ulnar collateral ligament Joint laxity Stress testing Goniometry Gamekeeper's thumb Skier's thumb

Get full access to this article

View all access options for this article.

References

Bowers

Hurst

. Gamekeeper's thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59:519–24.

Calder

Tennent

Allen

. Assessment of the efficacy of Proguard RR-2 radio-protective gloves during forearm manipulation. Injury. 2003;34(2):159–61.

Coonrad

Goldner

. A study of the pathological findings and treatment in soft-tissue injury of the thumb metacarpophalangeal joint. With a clinical study of the normal range of motion in one thousand thumbs and a study of post mortem findings of ligamentous structures in relation to function. J Bone Joint Surg Am. 1968;50:439–51.

Demirel

Turhan

Dereboy

. Surgical treatment of skier's thumb injuries: case report and review of the literature. Mt Sinai J Med. 2006;73:818–21.

Heyman

Gelberman

Duncan

. Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Biomechanical and prospective clinical studies on the usefulness of valgus stress testing. Clin Orthop Relat Res. 1993;292:165–71.

Louis

Buckwalter

. Magnetic resonance imaging of the collateral ligaments of the thumb. J Hand Surg Am. 1989;14 (4):739–41.

Palmer

Louis

. Assessing ulnar instability of the metacarpophalangeal joint of the thumb. J Hand Surg Am. 1978;3:542–6.

Patel

Potty

Taylor

Sorene

. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strat Trauma Limb Reconstr. 2010;5(1):1–10.

Posner

Retaillaud

. Metacarpophalangeal joint injuries of the thumb. Hand Clin. 1992;8:713–32.

10.

Sakellarides

DeWeese

. Instability of the metacarpophalangeal joint of the thumb. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. J Bone Joint Surg Am. 1976;58:106–12.

11.

Schnur

DeLone

McClellan

Bonavita

Witham

. Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg. 2002;49(1):19–23.

Fluoroscopy-Assisted Stress Testing of the Thumb Metacarpophalangeal Joint to Assess the Ulnar Collateral Ligament