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3b - Answer: 19-year-old male presents with hyperextension of left thumb

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

HISTORY: 

This 19-year-old male presents with hyperextension of left thumb one week prior, and pain.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Stener lesion.

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

FINDINGS:

Tear of proximal ulnar collateral ligament from the 1st metacarpal attachment with no Stener lesion. Ligament is macerated with 2 mm separation from the metacarpal head. The sagittal band is injured. Low grade sprain of the radial collateral ligament. Tear of the ulnar side capsule of the first metacarpophalangeal joint. Volar plate injured from the proximal attachment. The intersesamoid ligament torn with widened intersesamoid space.

Muscular strain of the adductor pollicis and opponens pollicis muscles. 

CONCLUSION: 

1. Shredded ulnar collateral ligament from proximal attachment at the 1st metacarpophalangeal joint, may need graft.  Associated radial collateral ligament sprain. 

2. Tear of the ulnar aspect of the capsule with volar plate injury. Intersesamoid ligament tear with widened intersesamoid space.

3. Grade 1 muscular strains of the opponens pollicis and adductor pollicis muscles.

LESSON 2, TOPIC 9

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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