Role of MR imaging in the management of “skier’s thumb” injuries.

Plancher KD, Ho CP, Cofield SS, Viola R, Hawkins RJ. Magn Reson Imaging Clin N Am 1999 Feb;7(1):73-84, viii.

“Skier’s thumb” is an acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb. As the method of choice in evaluating soft tissue injuries, MR imaging is useful in evaluating UCL injuries. This article reviews current concepts regarding the rupture of the UCL, including a study of 34 UCL injuries in which MR imaging was used as the main diagnostic tool. When correlated with surgical findings, MR imaging resulted in identifying UCL tears with 96% sensitivity and 95% specificity.

Sonography of the injured ulnar collateral ligament of the thumb.

Hergan K, Mittler C. J Bone Joint Surg Br 1995 Jan;77(1):77-83.

We used high-resolution ultrasonography to image the ulnar collateral ligament in 39 patients who had sustained recent injuries of the metacarpophalangeal joint of the thumb. All the patients were subsequently operated on and the lesions of the ligament were recorded. In 36 patients the preoperative ultrasonographic diagnosis was correct. Five of these showed no rupture of the ligament. In the other 31, ultrasonography correctly distinguished between rupture in situ (15) and rupture with dislocation of the ligament (16). Misdiagnosis by ultrasonography in three cases was due to delay of the investigation (three weeks after injury) in one, to technical error in one and to misinterpretation of the image in one.

The skier’s thumb.

Heim D. Acta Orthop Belg 1999 Dec;65(4):440-6.

The incidence of skier’s thumb (rupture of the ulnar collateral ligament of the first metacarpophalangeal joint) is increasing. To determine whether conservative or surgical treatment is indicated, ultrasound (US) and magnetic resonance imaging (MRI) have been advocated in the last few years. Surgery should be performed in the case of an unstable joint with a ligamentous tear or in the presence of a displaced bony fragment. Several techniques for surgical repair in acute and old ruptures are proposed. Conservative and postoperative treatment consists of immobilization of the joint in a splint or thumb spica cast for 4 weeks. The best results are obtained in bony avulsion fractures. Conservative treatment of lesions requiring surgical treatment may result in permanent disability of the joint; thus, correct diagnosis is mandatory.