Saturday, March 29, 2008

Evaluation of Thumb RCL Tears

A while ago, I discussed a case of a tear of the ulnar collateral ligament (UCL) of the first MCP joint, an injury also known as Gamekeeper's thumb. The radial collateral ligament of the thumb can also be injured. Here is a case of a patient who sustained an injury to his thumb while doing karate.

Oblique coronal intermediate-weighted images, anterior to posterior. There is a frank tear of the RCL (red arrow). Note the UCL (green arrow), which contains subtle abnormal signal, representing a concurrent grade 1 sprain of the UCL.

(click on image to enlarge)
Injury of the RCL was discussed by Coyle (J. Hand Surg. 2003;28A:14-20). He noted that RCL tears are often missed, because functional grasp and pinch complaints are often minimal. There is no general agreement on appropriate treatment of these lesions, with some authors suggesting casting, and others surgical repair. Interestingly, a Stener-equivalent lesion can occur, with the abductor aponeurosis interposing itself between the torn RCL and the base of the proximal phalanx.

Vic David MD

1 comment:

Anonymous said...

Helpful on the run. Thanks!