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15b - Answer: 62-year-old female fell three weeks prior, injuring left thumb

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 62-year-old female fell three weeks prior, injuring left thumb with pain in the region of the 1st metacarpophalangeal joint ever since.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

The distal aspect of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is torn. A portion of the dorsal aspect of the ulnar collateral ligament extends proximal to and superficial to the adductor aponeurosis, compatible with a Stener lesion. The radial collateral ligament of the metacarpophalangeal joint of the thumb remains intact. The radial and ulnar collateral ligaments of the interphalangeal joint of the thumb remain intact. 

Severe osteoarthritis is present at the 1st carpometacarpal joint with large spur and high-grade chondromalacia and underlying subchondral bone marrow reaction involving both articular surfaces. No substantive arthrosis is apparent at the 1st metacarpophalangeal joint or interphalangeal joint of the thumb. 

The extensor and flexor tendons of the thumb (and the tendons within the visualized radial-most aspect of the hand) are intact with no evidence of tendinosis, tenosynovitis, or tendon tear. 

Subcutaneous edema / soft tissue swelling is present within the thumb. 

CONCLUSION: 

1. The distal aspect of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is torn/ruptured. Additionally, the dorsal aspect of the ulnar collateral ligament extends proximal and superficial to the adductor aponeurosis, compatible with a Stener lesion. 

2. Severe osteoarthritis of the 1st carpometacarpal joint. Chronic tear of superficial and deep anterior oblique "beak" ligament (AOL). 

3. Subcutaneous edema/soft tissue swelling within the left thumb.

LESSON 2, TOPIC 45

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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