Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb

Abstract

The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.

Keywords

thumb - metacarpophalangeal joint - trapeziometacarpal joint - ulnar collateral ligament - sesamoid bone

Publication History

Article published online:
09 August 2021

• References

• 1 Melville DM, Taljanovic MS, Scalcione LR. et al. Imaging and management of thumb carpometacarpal joint osteoarthritis. Skeletal Radiol 2015; 44 (02) 165-177
• 2 Hirschmann A, Sutter R, Schweizer A, Pfirrmann CW. MRI of the thumb: anatomy and spectrum of findings in asymptomatic volunteers. AJR Am J Roentgenol 2014; 202 (04) 819-827
• 3 Gondim Teixeira PA, Omoumi P, Trudell DJ, Ward SR, Blum A, Resnick DL. High-resolution ultrasound evaluation of the trapeziometacarpal joint with emphasis on the anterior oblique ligament (beak ligament). Skeletal Radiol 2011; 40 (07) 897-904
• 4 Koo BS, Song Y, Sung YK, Lee S, Jun JB. Prevalence and distribution of sesamoid bones in the hand determined using digital tomosynthesis. Clin Anat 2017; 30 (05) 608-613
• 5 Chen W, Cheng J, Sun R. et al. Prevalence and variation of sesamoid bones in the hand: a multi-center radiographic study. Int J Clin Exp Med 2015; 8 (07) 11721-11726
• 6 Draghi F, Gitto S, Bianchi S. Injuries to the collateral ligaments of the metacarpophalangeal and interphalangeal joints: sonographic appearance. J Ultrasound Med 2018; 37 (09) 2117-2133
• 7 Rawat U, Pierce JL, Evans S, Chhabra AB, Nacey NC. High-resolution MR imaging and US anatomy of the thumb. Radiographics 2016; 36 (06) 1701-1716
• 8 Owings FP, Calandruccio JH, Mauck BM. Thumb ligament injuries in the athlete. Orthop Clin North Am 2016; 47 (04) 799-807
• 9 Kadow TR, Fowler JR. Thumb injuries in athletes. Hand Clin 2017; 33 (01) 161-173
• 10 Gupta S, Michelsen-Jost H. Anatomy and function of the thenar muscles. Hand Clin 2012; 28 (01) 1-7
• 11 Bayat A, Shaaban H, Giakas G, Lees VC. The pulley system of the thumb: anatomic and biomechanical study. J Hand Surg Am 2002; 27 (04) 628-635
• 12 Zafonte B, Rendulic D, Szabo RM. Flexor pulley system: anatomy, injury, and management. J Hand Surg Am 2014; 39 (12) 2525-2532 ; quiz 2533
• 13 Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-424
• 14 Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg 2001; 122 (04) 682-686
• 15 Miletin J, Sukop A, Baca V, Kachlik D. Arterial supply of the thumb: systemic review. Clin Anat 2017; 30 (07) 963-973
• 16 Petrover D, Bellity J, Vigan M, Nizard R, Hakime A. Ultrasound imaging of the thenar motor branch of the median nerve: a cadaveric study. Eur Radiol 2017; 27 (11) 4883-4888
• 17 Bianchi S, Becciolini M, Urigo C. Ultrasound imaging of disorders of small nerves of the extremities: less recognized locations. J Ultrasound Med 2019; 38 (11) 2821-2842
• 18 Goto A, Leng S, Sugamoto K, Cooney III WP, Kakar S, Zhao K. In vivo pilot study evaluating the thumb carpometacarpal joint during circumduction. Clin Orthop Relat Res 2014; 472 (04) 1106-1113
• 19 Kawanishi Y, Oka K, Tanaka H, Okada K, Sugamoto K, Murase T. In vivo 3-dimensional kinematics of thumb carpometacarpal joint during thumb opposition. J Hand Surg Am 2018; 43 (02) 182.e1-182.e7
• 20 Kerkhof FD, Brugman E, D'Agostino P. et al. Quantifying thumb opposition kinematics using dynamic computed tomography. J Biomech 2016; 49 (09) 1994-1999
• 21 Kimura T, Takai H, Azuma T, Sairyo K. Motion analysis of the trapeziometacarpal joint using three-dimensional computed tomography. J Hand Surg Asian Pac Vol 2016; 21 (01) 78-84
• 22 Wieschhoff GG, Sheehan SE, Wortman JR. et al. Traumatic finger injuries: what the orthopedic surgeon wants to know. Radiographics 2016; 36 (04) 1106-1128
• 23 Kapandji TG, Kapandji AI. New radiologic data on the trapezo-metacarpal joint. The results of 330 cases. [in French]. Ann Chir Main Memb Super 1993; 12 (04) 263-274
• 24 Gedda KO. Studies on Bennett's fracture; anatomy, roentgenology, and therapy. Acta Chir Scand Suppl 1954; 193: 1-114
• 25 Dela Rosa TL, Vance MC, Stern PJ. Radiographic optimization of the Eaton classification. J Hand Surg [Br] 2004; 29 (02) 173-177
• 26 Shin YH, Kim J, Baek GH. The peritrapezial view: new radiograph for evaluating joints around trapezium. J Orthop Surg (Hong Kong) 2018; 26 (01) 2309499018762846
• 27 Ladd AL. Guest editorial: The Robert's view: a historical and clinical perspective. Clin Orthop Relat Res 2014; 472 (04) 1097-1100
• 28 De Smet AA, Doherty MP, Norris MA, Hollister MC, Smith DL. Are oblique views needed for trauma radiography of the distal extremities?. AJR Am J Roentgenol 1999; 172 (06) 1561-1565
• 29 Ottenin MA, Jacquot A, Grospretre O. et al. Evaluation of the diagnostic performance of tomosynthesis in fractures of the wrist. AJR Am J Roentgenol 2012; 198 (01) 180-186
• 30 Noël A, Ottenin MA, Germain C. et al. Comparison of irradiation for tomosynthesis and CT of the wrist. [in French]. J Radiol 2011; 92 (01) 32-39
• 31 Blum A, Noël A, Regent D, Villani N, Gillet R, Gondim Teixeira P. Tomosynthesis in musculoskeletal pathology. Diagn Interv Imaging 2018; 99 (7–8): 423-441
• 32 Folio LR. Patient-controlled stress radiography of the thumb. Radiol Technol 1999; 70 (05) 465-469
• 33 Marchessault JA, Knight MC, Henkel PA. Diamond stress view radiograph for thumb metacarpophalangeal hyperextension. Hand (N Y) 2019; 14 (03) 393-397
• 34 Dominguez Gonzalez JJ, Zorrilla Ribot P, Perez Riverol EN, Martinez Rodriguez AS. Simultaneous bilateral functional radiography in ulnar collateral ligament lesion of the thumb: an original technique. Am J Orthop 2015; 44 (08) 359-362
• 35 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (08) 1655-1666
• 36 Wolf JM, Oren TW, Ferguson B, Williams A, Petersen B. The carpometacarpal stress view radiograph in the evaluation of trapeziometacarpal joint laxity. J Hand Surg Am 2009; 34 (08) 1402-1406
• 37 Tagliafico A, Rubino M, Autuori A, Bianchi S, Martinoli C. Wrist and hand ultrasound. Semin Musculoskelet Radiol 2007; 11 (02) 95-104
• 38 Martinoli C, Bianchi S, Nebiolo M, Derchi LE, Garcia JF. Sonographic evaluation of digital annular pulley tears. Skeletal Radiol 2000; 29 (07) 387-391
• 39 Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol 2007; 17 (09) 2237-2247
• 40 Bianchi S, Martinoli C, Abdelwahab IF. High-frequency ultrasound examination of the wrist and hand. Skeletal Radiol 1999; 28 (03) 121-129
• 41 Bianchi S, Becciolini M. Ultrasound evaluation of sesamoid fractures of the hand: retrospective report of 13 patients. J Ultrasound Med 2019; 38 (07) 1913-1920
• 42 Bianchi S, Martinoli C, de Gautard R, Gaignot C. Ultrasound of the digital flexor system: normal and pathological findings. J Ultrasound 2007; 10 (02) 85-92
• 43 Lapegue F, Andre A, Brun C. et al. Traumatic flexor tendon injuries. Diagn Interv Imaging 2015; 96 (12) 1279-1292
• 44 Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal System. Berlin, Germany: Springer; 2007
• 45 Bordet B, Borne J, Fantino O, Pialat JB. US of the ulnar collateral ligament (UCL) at the first metacarpophalangeal (MCP) joint: a new dynamic maneuver to detect Stener lesions. [in French]. J Radiol 2009; 90 (02) 217-220
• 46 Blum A, Walter F, Ludig T, Zhu X, Roland J. Multislice CT: principles and new CT-scan applications. [in French]. J Radiol 2000; 81 (11) 1597-1614
• 47 Blum A, Gillet R, Rauch A. et al. 3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: past, present and future. Diagn Interv Imaging 2020; 101 (11) 693-705
• 48 Rowe SP, Fritz J, Fishman EK. CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering. Emerg Radiol 2018; 25 (01) 93-101
• 49 Blum A, Kolopp M, Teixeira PG. et al. Synergistic role of newer techniques for forensic and postmortem CT examinations. AJR Am J Roentgenol 2018; 211 (01) 3-10
• 50 Teixeira PA, Gervaise A, Louis M. et al. Musculoskeletal wide-detector CT kinematic evaluation: from motion to image. Semin Musculoskelet Radiol 2015; 19 (05) 456-462
• 51 Strugarek-Lecoanet C, Chevrollier J, Pauchard N, Blum A, Dap F, Dautel G. Morphology and mobility of the reconstructed basilar joint of the pollicized index finger. J Hand Surg Am 2016; 41 (09) e267-e272
• 52 Gondim Teixeira PA, Formery AS, Hossu G. et al. Evidence-based recommendations for musculoskeletal kinematic 4D-CT studies using wide area-detector scanners: a phantom study with cadaveric correlation. Eur Radiol 2017; 27 (02) 437-446
• 53 Athlani L, Rouizi K, Granero J. et al. Assessment of scapholunate instability with dynamic computed tomography. J Hand Surg Eur Vol 2020; 45 (04) 375-382
• 54 Blum AG, Zabel JP, Kohlmann R. et al. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 2006; 26 (04) 1021-1044
• 55 Blum AG, Gillet R, Athlani L. et al. CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings. Insights Imaging 2021; 12 (01) 16
• 56 Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 2013; 94 (04) 371-388
• 57 Blum A, Gervaise A, Teixeira P. Iterative reconstruction: why, how and when?. Diagn Interv Imaging 2015; 96 (05) 421-422
• 58 Giese J, Cerniglia C. Soft tissue injuries of the finger and thumb. Semin Ultrasound CT MR 2018; 39 (04) 397-410
• 59 Ebrahim FS, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA. US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics 2006; 26 (04) 1007-1020
• 60 Lévêque E. Techniques d'IRM ostéo-articulaire. Montpellier, France: Sauramps Medical; 2010