Download PDF
Semin Musculoskelet Radiol 2021; 25(02): 355-365
DOI: 10.1055/s-0041-1730414
Review Article

Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions

Alain G. Blum 
1   Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France
2   Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
,
Marnix T. van Holsbeeck 
3   Musculoskeletal Radiology, Henry Ford Hospital, Detroit, Michigan
,
Stefano Bianchi 
4   CIM SA, Cabinet d'imagerie médicale, Geneva, Switzerland
5   Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva 14, Switzerland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.

Keywords

Stener's lesion - thumb metacarpophalangeal joint injuries - ulnar collateral ligament - sesamoid fractures - foreign body


Publication History

Article published online:
27 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Clark DP, Scott RN, Anderson IW. Hand problems in an accident and emergency department. J Hand Surg [Br] 1985; 10 (03) 297-299
    CrossrefPubMedGoogle Scholar
  • 2 Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol 2007; 32 (06) 626-636
    CrossrefPubMedGoogle Scholar
  • 3 Kadow TR, Fowler JR. Thumb injuries in athletes. Hand Clin 2017; 33 (01) 161-173
    CrossrefPubMedGoogle Scholar
  • 4 Rettig AC. Epidemiology of hand and wrist injuries in sports. Clin Sports Med 1998; 17 (03) 401-406
    CrossrefPubMedGoogle Scholar
  • 5 Owings FP, Calandruccio JH, Mauck BM. Thumb ligament injuries in the athlete. Orthop Clin North Am 2016; 47 (04) 799-807
    CrossrefPubMedGoogle Scholar
  • 6 Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine skiing injuries. Sports Health 2019; 11 (01) 18-26
    CrossrefPubMedGoogle Scholar
  • 7 Crestani L. Epidemiologie des accidents de ski alpin en équipe de France: étude rétrospective de 1994 à 2011 [thesis]. Nancy, France: Université de Lorraine; 2012
    Google Scholar
  • 8 Pomares G, Coudane H, Dap F, Dautel G. Epidemiology of traumatic upper limb amputations. Orthop Traumatol Surg Res 2018; 104 (02) 273-276
    CrossrefPubMedGoogle Scholar
  • 9 Wieschhoff GG, Sheehan SE, Wortman JR. et al. Traumatic finger injuries: what the orthopedic surgeon wants to know. Radiographics 2016; 36 (04) 1106-1128
    CrossrefPubMedGoogle Scholar
  • 10 Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 2009; 34 (05) 945-952
    CrossrefPubMedGoogle Scholar
  • 11 Liverneaux PA, Ichihara S, Hendriks S, Facca S, Bodin F. Fractures and dislocation of the base of the thumb metacarpal. J Hand Surg Eur Vol 2015; 40 (01) 42-50
    CrossrefPubMedGoogle Scholar
  • 12 Bianchi S, Abdelwahab IF, Zwass A, Molini L. Fractures of the sesamoid bone of the thumb. Bull Hosp Jt Dis 1993; 53 (03) 7-10
    PubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Hansen CA, Peterson TH. Fracture of the thumb sesamoid bones. J Hand Surg Am 1987; 12 (02) 269-270
    CrossrefPubMedGoogle Scholar
  • 15 Becciolini M, Bonacchi G. Fracture of the sesamoid bones of the thumb associated with volar plate injury: ultrasound diagnosis. J Ultrasound 2015; 18 (04) 395-398
    CrossrefPubMedGoogle Scholar
  • 16 Vögelin E. Ultrasonography: the third eye of hand surgeons. J Hand Surg Eur Vol 2020; 45 (03) 219-225
    CrossrefPubMedGoogle Scholar
  • 17 van der Naald M, van der Naald N, van der Velde D, Schuurman AH. Fracture of the sesamoid bone of the thumb: a case report and review of the literature. JBJS Case Connect 2019; 9 (01) e10
    CrossrefPubMedGoogle Scholar
  • 18 Kohyama S, Tanaka T, Ikumi A, Totoki Y, Okuno K, Ochiai N. Trapezium fracture associated with thumb carpometacarpal joint dislocation: a report of three cases and literature review. Case Rep Orthop 2018; 2018: 2408708
    PubMedGoogle Scholar
  • 19 Garavaglia G, Bianchi S, Santa DD, Fusetti C. Trans-trapezium carpo-metacarpal dislocation of the thumb. Arch Orthop Trauma Surg 2004; 124 (01) 67-68
    CrossrefPubMedGoogle Scholar
  • 20 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
    CrossrefPubMedGoogle Scholar
  • 21 Daley D, Geary M, Gaston RG. Thumb metacarpophalangeal ulnar and radial collateral ligament injuries. Clin Sports Med 2020; 39 (02) 443-455
    CrossrefPubMedGoogle Scholar
  • 22 Avery III DM, Caggiano NM, Matullo KS. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Orthop Clin North Am 2015; 46 (02) 281-292
    CrossrefPubMedGoogle Scholar
  • 23 Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE. Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med 2012; 40 (04) 770-776
    CrossrefPubMedGoogle Scholar
  • 24 Tagliafico A, Rubino M, Autuori A, Bianchi S, Martinoli C. Wrist and hand ultrasound. Semin Musculoskelet Radiol 2007; 11 (02) 95-104
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Lark ME, Maroukis BL, Chung KC. The Stener lesion: historical perspective and evolution of diagnostic criteria. Hand (N Y) 2017; 12 (03) 283-289
    CrossrefPubMedGoogle Scholar
  • 26 Rhee PC, Kakar S. Chronic thumb metacarpophalangeal joint ulnar collateral ligament insufficiency. J Hand Surg Am 2012; 37 (02) 346-348 ; quiz 349
    CrossrefPubMedGoogle Scholar
  • 27 Singh JP, Kumar S, Kathiria AV, Harjai R, Jawed A, Gupta V. Thumb ultrasound: technique and pathologies. Indian J Radiol Imaging 2016; 26 (03) 386-396
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Mahajan M, Tolman C, Würth B, Rhemrev SJ. Clinical evaluation vs magnetic resonance imaging of the skier's thumb: a prospective cohort of 30 patients. Eur J Radiol 2016; 85 (10) 1750-1756
    CrossrefPubMedGoogle Scholar
  • 29 Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg Br 1962; 44: 869-879
    CrossrefPubMedGoogle Scholar
  • 30 Stener B. Skeletal injuries associated with rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. A clinical and anatomical study. Acta Chir Scand 1963; 125: 583-586
    PubMedGoogle Scholar
  • 31 McKeon KE, Gelberman RH, Calfee RP. Ulnar collateral ligament injuries of the thumb: phalangeal translation during valgus stress in human cadavera. J Bone Joint Surg Am 2013; 95 (10) 881-887
    CrossrefPubMedGoogle Scholar
  • 32 Bronstein AJ, Koniuch MP, von Holsbeeck M. Ultrasonographic detection of thumb ulnar collateral ligament injuries: a cadaveric study. J Hand Surg Am 1994; 19 (02) 304-312
    CrossrefPubMedGoogle Scholar
  • 33 van Holsbeeck M, Introcaso J. Musculoskeletal Ultrasound. 3rd ed.. New Delhi, India: Jaypee Brothers Medical Publishers; 2016
    Google Scholar
  • 34 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
    CrossrefPubMedGoogle Scholar
  • 35 Bordet B, Borne J, Fantino O, Pialat JB. US of the ulnal 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
    CrossrefPubMedGoogle Scholar
  • 36 Melville DM, Jacobson JA, Fessell DP. Ultrasound of the thumb ulnar collateral ligament: technique and pathology. AJR Am J Roentgenol 2014; 202 (02) W168
    CrossrefPubMedGoogle Scholar
  • 37 Melville D, Jacobson JA, Haase S, Brandon C, Brigido MK, Fessell D. Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. Skeletal Radiol 2013; 42 (05) 667-673
    CrossrefPubMedGoogle Scholar
  • 38 Milner CS, Manon-Matos Y, Thirkannad SM. Gamekeeper's thumb—a treatment-oriented magnetic resonance imaging classification. J Hand Surg Am 2015; 40 (01) 90-95
    CrossrefPubMedGoogle Scholar
  • 39 Bhat AK, Mane PP, Acharya A, Madi S. Simultaneous combined complete tear of radial and ulnar collateral ligaments of thumb in an adolescent. BMJ Case Rep 2017; 2017: bcr-2017-220550
    CrossrefPubMedGoogle Scholar
  • 40 Werner BC, Belkin NS, Kennelly S. et al. Injuries to the collateral ligaments of the metacarpophalangeal joint of the thumb, including simultaneous combined thumb ulnar and radial collateral ligament injuries, in National Football League Athletes. Am J Sports Med 2017; 45 (01) 195-200
    CrossrefPubMedGoogle Scholar
  • 41 Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med 2015; 34 (01) 117-126
    CrossrefPubMedGoogle Scholar
  • 42 Giese J, Cerniglia C. Soft tissue injuries of the finger and thumb. Semin Ultrasound CT MR 2018; 39 (04) 397-410
    CrossrefPubMedGoogle Scholar
  • 43 Anderson MA, Newmeyer III WL, Kilgore Jr ES. Diagnosis and treatment of retained foreign bodies in the hand. Am J Surg 1982; 144 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 44 Hollander JE, Singer AJ, Valentine S, Henry MC. Wound registry: development and validation. Ann Emerg Med 1995; 25 (05) 675-685
    CrossrefPubMedGoogle Scholar
  • 45 Jarraya M, Hayashi D, de Villiers RV. et al. Multimodality imaging of foreign bodies of the musculoskeletal system. AJR Am J Roentgenol 2014; 203 (01) W92–W102
    CrossrefPubMedGoogle Scholar
  • 46 Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics 2001; 21 (05) 1251-1256
    CrossrefPubMedGoogle Scholar
  • 47 Pierucci A, Teixeira P, Zimmermann V. et al. Tumours and pseudotumours of the soft tissue in adults: perspectives and current role of sonography. Diagn Interv Imaging 2013; 94 (03) 238-254
    CrossrefPubMedGoogle Scholar
  • 48 Callegari L, Leonardi A, Bini A. et al. Ultrasound-guided removal of foreign bodies: personal experience. Eur Radiol 2009; 19 (05) 1273-1279
    CrossrefPubMedGoogle Scholar
  • 49 Huttin C, Diaz JJH, Vernet P, Facca S, Igeta Y, Liverneaux P. Relevance of intraoperative ultrasound imaging for detecting foreign bodies in the hand: a series of 19 cases. Hand Surg Rehabil 2018; 37 (06) 363-367
    Google Scholar
  • 50 Gilman L, Cage DN, Horn A, Bishop F, Klam WP, Doan AP. Tendon rupture associated with excessive smartphone gaming. JAMA Intern Med 2015; 175 (06) 1048-1049
    CrossrefPubMedGoogle Scholar
  • 51 Cohen M. US imaging in operated tendons. J Ultrasound 2012; 15 (01) 69-75
    CrossrefPubMedGoogle Scholar
  • 52 Brown MS, O'Donnell J, Walz D. Closed rupture of the flexor tendon pulleys of the thumb. Clin Imaging 2019; 58: 66-69
    CrossrefPubMedGoogle Scholar
  • 53 Kosiyatrakul A, Jitprapaikulsarn S, Durand S, Oberlin C. Closed flexor pulley rupture of the thumb: case report and review of literature. Hand Surg 2009; 14 (2–3): 139-142
    CrossrefPubMedGoogle Scholar
  • 54 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
    CrossrefPubMedGoogle Scholar
  • 55 Jacobson JA, Wilson TJ, Yang LJ. Sonography of common peripheral nerve disorders with clinical correlation. J Ultrasound Med 2016; 35 (04) 683-693
    CrossrefPubMedGoogle Scholar
  • 56 Causeret A, Ract I, Jouan J, Dreano T, Ropars M, Guillin R. A review of main anatomical and sonographic features of subcutaneous nerve injuries related to orthopedic surgery. Skeletal Radiol 2018; 47 (08) 1051-1068
    CrossrefPubMedGoogle Scholar
  • 57 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
    CrossrefPubMedGoogle Scholar
  • 58 Wajid H, LeBlanc J, Shapiro DB, Delzell PB. Bowler's thumb: ultrasound diagnosis of a neuroma of the ulnar digital nerve of the thumb. Skeletal Radiol 2016; 45 (11) 1589-1592
    CrossrefPubMedGoogle Scholar
  • 59 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
    CrossrefPubMedGoogle Scholar
  • 60 Ruebhausen MR, Berry NN. Drummer's thumb: ulnar digital artery thrombosis and aneurismal change from repetitive drumstick trauma after carpal-metacarpal arthroplasty. Eplasty 2019; 19: ic15
    PubMedGoogle Scholar