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5b - Answer: 15-year-old female is being assessed for ulnar collateral ligament tear in right thumb

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

HISTORY: 

This 15-year-old female is being assessed for ulnar collateral ligament tear in right thumb.

(QUIZ ANSWER) MOST LIKELY PRIMARY FINDING IN THIS CASE: 

Non-Stener ulnar collateral ligament (UCL) tear.

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

FINDINGS: 

Two separate fractures are noted involving the distal portion of the 1st metacarpal bone. Nondisplaced, nonangulated, nondistracted transverse fracture noted at the junction of the middle and distal thirds of the 1st metacarpal. The second nondisplaced, nonangulated, nondistracted fracture noted oriented longitudinally extending from the palmar aspect of the distal diametaphyseal junction distally. T1 images demonstrate the anatomy of the fractures very well and fluid-sensitive signal demonstrate marked perifracture edema. Also noted is microtrabecular injury involving both sesamoids at the 1st CMC joint. Likely crush related. The intersesamoidal ligament and sesamoidal phalangeal ligaments appear intact. 

A small cleft of fluid signal intensity interrupts the distal attachment site for the ulnar collateral ligament compatible with grade 1 tear without evidence for ligament retraction. No Stener lesion. Normal appearance of the adductor aponeurosis. Generalized soft tissue swelling noted along the entire superficial aspect of the ulnar collateral ligament. 

Normal appearance of the radial collateral ligament. 

Small effusion noted at the 1st CMC joint space. Mild cancellous edema along the radial aspect of the proximal phalanx of the thumb compatible with impaction from valgus forces.

Musculature is intact without evidence for denervation, fatty infiltration, or volumetric atrophy. 

No other bony or soft tissue injury is noted.

IMPRESSION: 

Small linear cleft of fluid is noted interrupting the distal attachment site of the ulnar collateral ligament of the thumb compatible with grade 1 non-Stener tear but without evidence for any proximal retraction, crimping, displacement or joint space entrapment. Normal adductor aponeurosis. 

Mild generalized soft tissue swelling along the superficial aspect of the ulnar collateral ligament. 

Microtrabecular injuries involving both sesamoids without evidence for disruption or tear involving intersesamoidal ligament or either sesamoid phalangeal ligament. 

Small effusion at the 1st CMC joint. 

Transverse and longitudinally oriented fractures involving the distal 1st metacarpal bone without evidence for angulation, displacement, distraction, or other fracture complication. Impaction fracture at the radial aspect of the proximal phalanx thumb from valgus forces.

LESSON 2, TOPIC 15

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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