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.
Methods
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.
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References
Bowers WH, Hurst LC. Gamekeeper’s thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59:519–24.
Calder PR, Tennent TD, Allen PW. Assessment of the efficacy of Proguard RR-2 radio-protective gloves during forearm manipulation. Injury. 2003;34(2):159–61.
Coonrad RW, Goldner JL. 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 M, Turhan E, Dereboy F, et al. Surgical treatment of skier’s thumb injuries: case report and review of the literature. Mt Sinai J Med. 2006;73:818–21.
Heyman P, Gelberman RH, Duncan K, et al. 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 DS, Buckwalter KA. Magnetic resonance imaging of the collateral ligaments of the thumb. J Hand Surg Am. 1989;14(4):739–41.
Palmer AK, Louis DS. Assessing ulnar instability of the metacarpophalangeal joint of the thumb. J Hand Surg Am. 1978;3:542–6.
Patel S, Potty A, Taylor EJ, Sorene ED. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strat Trauma Limb Reconstr. 2010;5(1):1–10.
Posner MA, Retaillaud JL. Metacarpophalangeal joint injuries of the thumb. Hand Clin. 1992;8:713–32.
Sakellarides HT, DeWeese JW. 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.
Schnur DP, DeLone FX, McClellan RM, Bonavita J, Witham RS. Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg. 2002;49(1):19–23.
Acknowledgments
We would like to thank Maya Deza Culbertson for her helpful input during the writing of this manuscript.
Conflict of Interest
The authors declare that they have no conflict of interest.
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Patel, A., Patel, A., Edelstein, D. et al. Fluoroscopy-assisted stress testing of the thumb metacarpophalangeal joint to assess the ulnar collateral ligament. HAND 8, 205–209 (2013). https://doi.org/10.1007/s11552-013-9500-2
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DOI: https://doi.org/10.1007/s11552-013-9500-2