Skeletal Radiology

, Volume 42, Issue 8, pp 1105–1112 | Cite as

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

  • Anna Hirschmann
  • Reto Sutter
  • Andreas Schweizer
  • Christian W. A. Pfirrmann
Scientific Article



To prospectively characterize the MR appearance of the carpometacarpal (CMC) joint of the thumb in asymptomatic volunteers.

Materials and methods

Thirty-four asymptomatic volunteers (17 women, 17 men, mean age, 33.9 ± 9.2 years) underwent MR imaging of the thumb after approval by the local ethical committee. Two musculoskeletal radiologists independently classified visibility and signal intensity (SI) characteristics of the anterior oblique (AOL/beak ligament), the posterior oblique (POL), the intermetacarpal (IML), and the dorsoradial ligaments (DRL) on a three-point Likert scale. The thickness of all ligaments, cartilage integrity, and presence of joint fluid were assessed. The alignment of the first metacarpal base with the trapezium was quantified on sagittal and coronal planes.


The ligaments of the CMC joint were constantly visible in all volunteers for the POL and IML, and in all but one for the AOL and DRL. On intermediate-weighted fat-saturated images the POL (65 %/74 % reader 1/reader 2) and DRL (58 %/64 %) were commonly of increased SI, while the IML had a striated appearance in 91 %/76 % of subjects. The AOL showed a variable SI (36 %/42 % low, 27 %/27 % increased, 36 %/30 % striated). The IML was the thickest ligament with a mean of 2.9 mm/3.1 mm and the DRL the thinnest (1.2 mm/1.4 mm). There was a mean dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation of 2.8 mm/3.4 mm of the metacarpal base. The AOL was significantly thicker in men (1.7 mm) than in women (1.2 mm; p = 0.02). Radial subluxation was significantly larger in men (3.4 mm) than in women (2.2 mm; p = 0.02). No subluxation in palmar or ulnar direction was seen.


Radial and dorsal subluxation of the CMC joint can be a normal finding in a resting position at MR imaging. The CMC ligaments showed a considerable variability of signal intensity with a typically striated IML; thickness of the AOL is typically less than 2.2 mm, of the POL typically less than 2.9 mm.


Carpometacarpal joint Thumb Magnetic resonance imaging 


  1. 1.
    Imaeda T, An KN, Cooney WP, Linscheid R. Anatomy of trapeziometacarpal ligaments. J Hand Surg. 1993;18A:226–31.Google Scholar
  2. 2.
    Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg. 2001;26 A:686–91.Google Scholar
  3. 3.
    Cardoso FN, Kim HJ, Albertotti F, Botte MJ, Resnick D, Chung CB. Imaging the ligaments of the trapeziometacarpal joint: MRI compared with MR arthrography in cadaveric specimens. AJR. 2009;192:W13–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Edmunds JO. Current concepts of the anatomy of the thumb trapeziometacarpal joint. J Hand Surg. 2011;36A:170–82.Google Scholar
  5. 5.
    Connell DA, Pike J, Koulouris G, van Wettering N, Hoy G. MR imaging of thumb carpometacarpal joint ligament injuries. J Hand Surg Br. 2004;29B(1):46–54.Google Scholar
  6. 6.
    Bosmans B, Verhofstad MHJ, Gosens T. Traumatic thumb carpometacarpal joint dislocation. J Hand Surg. 2008;33A:438–41.Google Scholar
  7. 7.
    Edmunds JO. Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb. Hand Clin. 2006;22:365–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Fotiadis E, Svarnas T, Lyrtzis C, Papadopoulos A, Akritopoulos P, Chalidis B. Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature. J Orthop Surg Res. 2010;5:16.PubMedCrossRefGoogle Scholar
  9. 9.
    Brownlie C, Anderson D. Bennett fracture dislocation - review and management. Aus Fam Physician. 2011;40(6):394–6.Google Scholar
  10. 10.
    Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg. 1993;18a:238–44.Google Scholar
  11. 11.
    Napier JR. The form and function of the carpometacarpal (CMC) joint. J Anat. 1955;89:362–9.PubMedGoogle Scholar
  12. 12.
    Bettinger PC, Linscheid RL, Berger RA, Cooney WP, Kai-Nan A. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg. 1999;24A:786–98.CrossRefGoogle Scholar
  13. 13.
    Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am. 1994;19:93–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg. 1998;23A:607–11.Google Scholar
  15. 15.
    Cooney W, Chao E. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg. 1977;59a:27–36.Google Scholar
  16. 16.
    Nanno M, Burford WL, Patterson RM, Andersen CR, Viegas SF. Three-dimensional analysis of the ligamentous attachments of the first carpometacarpal joint. J Hand Surg. 2006;31 A:1160–70.Google Scholar
  17. 17.
    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;40:897–904.PubMedCrossRefGoogle Scholar
  18. 18.
    Doerschuk SH, Hicks DG, Chinchilli VM, Pellegrini VD. Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis. J Hand Surg. 1999;24a:496–504.CrossRefGoogle Scholar
  19. 19.
    Husarik DB, Saupe N, Pfirrmann CWA, Jost B, Hodler J, Zanetti M. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 2010;257:185–94.PubMedCrossRefGoogle Scholar
  20. 20.
    Mengiardi B, Pfirrmann CWA, Vienne P, Hodler J, Zanetti M. Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology. 2007;242:817–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Pellegrini Jr VD. Pathomechanics of the thumb trapeziometacarpal joint. Hand Clin. 2001;17:175–84.PubMedGoogle Scholar
  22. 22.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Rosner BA. Fundamentals of Biostatistics 5th Edition. Duxbury 2000Google Scholar
  24. 24.
    Bojsen-Moller F. Osteoligamentous guidance of the movements of the human thumb. Am J Anat. 1976;147:71–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Pagalidis T, Kuczynski K, Lamb DW. Ligamentous stability of the base of the thumb. Hand. 1981;13:29–35.PubMedCrossRefGoogle Scholar
  26. 26.
    Eaton RG, Littler JW. A study of the basal joint of the thumb, treatment of its disabilities by fusion. J Bone Joint Surg. 1969;51a:661–8.Google Scholar
  27. 27.
    Eaton RG, Littler JW. Ligament reconstruction of the painful thumb carpometacarpal joint. J Bone Joint Surg. 1973;55a(8):802–6.Google Scholar
  28. 28.
    Xu L, Strauch RJ, Ateshian GA, Pawluk RJ, Mow VC, Rosenwasser MP. Topography of the osteoarthritic thumb carpometacarpal joint and its variation with regard to gender, age, site and osteoarthritic stage. J Hand Surg. 1998;23a:454–64.Google Scholar
  29. 29.
    Wolf JM, Oren TW, Ferguson B, Williams A, Peterson B. The carpometacarpal stress view radiograph in the evaluation of trapeziometacarpal joint laxity. J Hand Surg Am. 2009;34(8):1402–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Hayes CW, Paralleda JA. The magic angle effect in musculoskeletal MR imaging. Top Magn Reson Imaging. 1996;8(1):51–6.PubMedGoogle Scholar
  31. 31.
    Bydder M, Rahal A, Fullerton GD, Bydder GM. The magic angle effect: a source of artifact, determinant of image contrast, and technique for imaging. J Magn Reson Imaging. 2007;25(2):290–300.PubMedCrossRefGoogle Scholar
  32. 32.
    Badia A. Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints. J Hand Surg Am. 2007;32(5):707–24.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2013

Authors and Affiliations

  • Anna Hirschmann
    • 1
  • Reto Sutter
    • 1
  • Andreas Schweizer
    • 2
  • Christian W. A. Pfirrmann
    • 1
  1. 1.Department of RadiologyOrthopedic University Hospital Balgrist, University of ZurichZurichSwitzerland
  2. 2.Department of Orthopedic SurgeryOrthopedic University Hospital Balgrist, University of ZurichZurichSwitzerland

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