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Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint

Beatrice Knisely
Beatrice Knisely
, 
Shelley S. Noland
Shelley S. Noland
 and 
David M. Melville
David M. Melville
   | Nov 23, 2023
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Article Category: Review Paper
Published Online: Nov 23, 2023
Page range: e214 - e222
Received: Jul 05, 2023
Accepted: Jul 27, 2023
DOI: https://doi.org/10.15557/jou.2023.0030
Keywords
© 2023 Beatrice Knisely et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Anatomy of the thumb MCP joint. Illustrations depicting: A. Coronal and sagittal views of the relevant supporting structures at the thumb MCP joint including volar plate complex, consisting of the phalangoglenoid (PG) and checkrein (CR) ligaments. B. Transverse illustration at the level of the MCP joint shows important static stabilizers, along with key dynamic stabilizers: the extensor pollicis longus (EPL) and brevis (EPB), flexor pollicis longus (FPL), flexor pollicis brevis (FPB), and abductor pollicis brevis (APB). The adductor aponeurosis (AA) overlies the UCL. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved
Anatomy of the thumb MCP joint. Illustrations depicting: A. Coronal and sagittal views of the relevant supporting structures at the thumb MCP joint including volar plate complex, consisting of the phalangoglenoid (PG) and checkrein (CR) ligaments. B. Transverse illustration at the level of the MCP joint shows important static stabilizers, along with key dynamic stabilizers: the extensor pollicis longus (EPL) and brevis (EPB), flexor pollicis longus (FPL), flexor pollicis brevis (FPB), and abductor pollicis brevis (APB). The adductor aponeurosis (AA) overlies the UCL. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved

Fig. 2.

Musculotendinous anatomy of the thumb. Coronally oriented illustration depicting dynamic stabilizers including extensor pollicis longus (EPL), extensor pollicis brevis (EPB), as well as two associated static stabilizers, the radial (RCL) and ulnar collateral ligaments (UCL), with the latter lying deep to the adductor aponeurosis. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved
Musculotendinous anatomy of the thumb. Coronally oriented illustration depicting dynamic stabilizers including extensor pollicis longus (EPL), extensor pollicis brevis (EPB), as well as two associated static stabilizers, the radial (RCL) and ulnar collateral ligaments (UCL), with the latter lying deep to the adductor aponeurosis. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved

Fig. 3.

24-year-old female with right thumb volar plate injury. Longitudinal grayscale US image shows hypoechoic thickening and irregularity of the volar plate (white arrowheads) compared to the hyperechoic and smooth contralateral normal volar plate (black arrowheads). Dynamic US images during MCP joint flexion/extension demonstrate a focal hypoechoic cleft, consistent with tear (Video 1)
24-year-old female with right thumb volar plate injury. Longitudinal grayscale US image shows hypoechoic thickening and irregularity of the volar plate (white arrowheads) compared to the hyperechoic and smooth contralateral normal volar plate (black arrowheads). Dynamic US images during MCP joint flexion/extension demonstrate a focal hypoechoic cleft, consistent with tear (Video 1)

Fig. 4.

A. 33-year-old female with normal volar plate. Sagittal T2 fat-suppressed MR image demonstrates the normal intermediate signal synovial recess (curved arrow) between the volar plate and proximal phalanx, not to be mistaken for tear. B. 54-year-old male with partial volar plate injury. Sagittal T2 fat-suppressed MR image demonstrates edematous and thickened volar plate (arrow), consistent with a partial tear
A. 33-year-old female with normal volar plate. Sagittal T2 fat-suppressed MR image demonstrates the normal intermediate signal synovial recess (curved arrow) between the volar plate and proximal phalanx, not to be mistaken for tear. B. 54-year-old male with partial volar plate injury. Sagittal T2 fat-suppressed MR image demonstrates edematous and thickened volar plate (arrow), consistent with a partial tear

Fig. 5.

17-year-old female with radiographic and US-occult left thumb ulnar sesamoid fracture. A. Longitudinal grayscale US image demonstrates mild thickening and hypoechogenicity of the FPL tendon (arrow) compared to normal right thumb. No evidence of abnormality involving the left ulnar sesamoid (arrowhead). B. Coronal T2 fat-suppressed MR image shows transverse low signal fracture line (arrow) and accompanying bone marrow edema involving the ulnar sesamoid
17-year-old female with radiographic and US-occult left thumb ulnar sesamoid fracture. A. Longitudinal grayscale US image demonstrates mild thickening and hypoechogenicity of the FPL tendon (arrow) compared to normal right thumb. No evidence of abnormality involving the left ulnar sesamoid (arrowhead). B. Coronal T2 fat-suppressed MR image shows transverse low signal fracture line (arrow) and accompanying bone marrow edema involving the ulnar sesamoid

Fig. 6.

Full-thickness ulnar collateral ligament (UCL) tears. The illustration on the left depicts the mechanism of injury resulting in a nondisplaced fullthickness metacarpophalangeal joint UCL tear where the torn ligament remains beneath the adductor aponeurosis. On the right is a Stener lesion, where a torn and displaced UCL lies superficial and proximal to the adductor aponeurosis following injury. Extensor pollicis longus (EPL) and brevis (EPB). Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved
Full-thickness ulnar collateral ligament (UCL) tears. The illustration on the left depicts the mechanism of injury resulting in a nondisplaced fullthickness metacarpophalangeal joint UCL tear where the torn ligament remains beneath the adductor aponeurosis. On the right is a Stener lesion, where a torn and displaced UCL lies superficial and proximal to the adductor aponeurosis following injury. Extensor pollicis longus (EPL) and brevis (EPB). Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved

Fig. 7.

31-year-old male with Stener lesion undergoing repair. A. The balled-up, displaced UCL (arrow) is entrapped proximal to the adductor aponeurosis (arrowheads). B. An incision divides the adductor aponeurosis (arrowheads), and the torn UCL (arrow) is unfurled prior to reattachment with anchor to the thumb metacarpal base
31-year-old male with Stener lesion undergoing repair. A. The balled-up, displaced UCL (arrow) is entrapped proximal to the adductor aponeurosis (arrowheads). B. An incision divides the adductor aponeurosis (arrowheads), and the torn UCL (arrow) is unfurled prior to reattachment with anchor to the thumb metacarpal base

Fig. 8.

17-year-old female with Stener lesion. Coronal oblique T2 fat-suppressed MR image depicts the characteristic yo-yo (proximally displaced and mass-like UCL – curved arrow) on a string (adductor aponeurosis – arrow) appearance of Stener lesion
17-year-old female with Stener lesion. Coronal oblique T2 fat-suppressed MR image depicts the characteristic yo-yo (proximally displaced and mass-like UCL – curved arrow) on a string (adductor aponeurosis – arrow) appearance of Stener lesion

Fig. 9.

A. Photograph demonstrating positioning of the hand and US probe for scanning the UCL longitudinally in a coronal plane to the MCP joint. White line indicates position for transverse imaging. B. Using the coronal plane demonstrated above, a longitudinal grayscale US image of a 54-year-old female shows a normal UCL (dotted line) extending from the metacarpal head (MC) to the proximal phalangeal base (PP), with the thin overlying adductor aponeurosis (arrowheads). Note the anisotropy of the proximal UCL fibers (curved arrow). See Video 2 for normal clinical examination of the UCL
A. Photograph demonstrating positioning of the hand and US probe for scanning the UCL longitudinally in a coronal plane to the MCP joint. White line indicates position for transverse imaging. B. Using the coronal plane demonstrated above, a longitudinal grayscale US image of a 54-year-old female shows a normal UCL (dotted line) extending from the metacarpal head (MC) to the proximal phalangeal base (PP), with the thin overlying adductor aponeurosis (arrowheads). Note the anisotropy of the proximal UCL fibers (curved arrow). See Video 2 for normal clinical examination of the UCL

Fig. 10.

Nondisplaced and partial UCL tears. A. 29-year-old female with nondisplaced full-thickness UCL tear. Longitudinal US image shows fluid-filled cleft at the thumb proximal phalangeal base (curved arrow) with irregular, disrupted UCL fibers (arrow) deep to the thickened adductor aponeurosis (arrowheads). B. 37-year-old female with partial thickness UCL tear. Longitudinal US image shows thickening and hypoechogenicity with possible fluid-filled cleft involving the deep distal fibers (arrow). Note anisotropy proximally (arrowhead), not to be mistaken for tear. Dynamic imaging with slight valgus stress confirms presence of partial tear (Video 3)
Nondisplaced and partial UCL tears. A. 29-year-old female with nondisplaced full-thickness UCL tear. Longitudinal US image shows fluid-filled cleft at the thumb proximal phalangeal base (curved arrow) with irregular, disrupted UCL fibers (arrow) deep to the thickened adductor aponeurosis (arrowheads). B. 37-year-old female with partial thickness UCL tear. Longitudinal US image shows thickening and hypoechogenicity with possible fluid-filled cleft involving the deep distal fibers (arrow). Note anisotropy proximally (arrowhead), not to be mistaken for tear. Dynamic imaging with slight valgus stress confirms presence of partial tear (Video 3)

Fig. 11.

Stener Lesion – US. 31-year-old male with Stener lesion. A. Longitudinal US shows hypoechoic mass-like abnormality overlying the metacarpal head (arrows) proximal and superficial to the adductor aponeurosis (arrowheads), with no visible underlying ligamentous fibers, consistent with a completely torn and displaced UCL
Stener Lesion – US. 31-year-old male with Stener lesion. A. Longitudinal US shows hypoechoic mass-like abnormality overlying the metacarpal head (arrows) proximal and superficial to the adductor aponeurosis (arrowheads), with no visible underlying ligamentous fibers, consistent with a completely torn and displaced UCL

Fig. 12.

RCL Tear. 27-year-old male with left RCL tear. A. Initial coronal oblique T2 fat-suppressed MR image shows apparent high-grade partial thickness tear at the proximal phalangeal attachment of the RCL. B. Follow-up US to assess stability shows near full-thickness tear (arrow). Dynamic exam better demonstrates depth of tear with no asymmetric instability compared to right (not shown)
RCL Tear. 27-year-old male with left RCL tear. A. Initial coronal oblique T2 fat-suppressed MR image shows apparent high-grade partial thickness tear at the proximal phalangeal attachment of the RCL. B. Follow-up US to assess stability shows near full-thickness tear (arrow). Dynamic exam better demonstrates depth of tear with no asymmetric instability compared to right (not shown)

Fig. 13.

Multiligamentous injury. 41-year-old male with multiligamentous injury. Coronal T2 fat-suppressed MR image shows non-displaced fullthickness tear involving the distal UCL (curved arrow) with near-full thickness tear involving the RCL midsubstance (arrow). Associated dorsal capsular injury not shown
Multiligamentous injury. 41-year-old male with multiligamentous injury. Coronal T2 fat-suppressed MR image shows non-displaced fullthickness tear involving the distal UCL (curved arrow) with near-full thickness tear involving the RCL midsubstance (arrow). Associated dorsal capsular injury not shown

Fig. 14.

Pulley anatomy. Coronally oriented illustration showing the first (A1) and second (A2) annular pulleys at the level of MCP and interphalangeal joints, respectively. The oblique annular pulley (Ao) extends distally from the ulnar to radial aspects of the proximal phalanx with additional variable (Av) annular pulley located more proximally and following a similar trajectory. Both Ao and Av are contiguous with the adductor aponeurosis. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved
Pulley anatomy. Coronally oriented illustration showing the first (A1) and second (A2) annular pulleys at the level of MCP and interphalangeal joints, respectively. The oblique annular pulley (Ao) extends distally from the ulnar to radial aspects of the proximal phalanx with additional variable (Av) annular pulley located more proximally and following a similar trajectory. Both Ao and Av are contiguous with the adductor aponeurosis. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved

Fig. 15.

Pulley injury – MRI. 45-year-old female with A1 pulley complex tear. Axial images at the MCP joint (A) and proximal phalanx (B) show tear at the radial aspect of the A1 pulley (curved arrow) with volar displacement of the FPL (black arrowhead) with full-thickness tear of the Ao (white arrowhead) and undulation of the remaining obliquely oriented fibers (arrow)
Pulley injury – MRI. 45-year-old female with A1 pulley complex tear. Axial images at the MCP joint (A) and proximal phalanx (B) show tear at the radial aspect of the A1 pulley (curved arrow) with volar displacement of the FPL (black arrowhead) with full-thickness tear of the Ao (white arrowhead) and undulation of the remaining obliquely oriented fibers (arrow)

Fig. 16.

Trigger thumb. 67-year-old female with trigger thumb. Longitudinal grayscale (A) and power Doppler (B) US images show thickening (arrowheads) and hyperemia (arrow) of the A1 pulley at the MCP joint. Dynamic US images during interphalangeal joint flexion demonstrate severely restricted motion and tendon kinking distal to the thickened A1 pulley (Video 4).
Trigger thumb. 67-year-old female with trigger thumb. Longitudinal grayscale (A) and power Doppler (B) US images show thickening (arrowheads) and hyperemia (arrow) of the A1 pulley at the MCP joint. Dynamic US images during interphalangeal joint flexion demonstrate severely restricted motion and tendon kinking distal to the thickened A1 pulley (Video 4).
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