Patient History
75 M with pain in left thumb and difficulty moving it after injury.
Findings
LIGAMENTS: The proper ulnar collateral ligament (pUCL) is torn and detached from its insertion at the volar ulnar aspect of the thumb proximal phalanx. The ligament remains attached at its insertion in the ulnar volar aspect of the metacarpal head but projects superficial to the adductor pollicis tendon insertion.
The accessory ulnar collateral ligament (aUCL) remains attached at the ulnar sesamoid and volar plate.
The adductor aponeurosis is also intact.
The proper and accessory radial collateral ligaments and abductor aponeurosis remain intact.
OSSEOUS: Mild radial subluxation of the thumb proximal phalangeal base.
Focal cortical irregularity at the volar ulnar aspect of the thumb proximal phalangeal base at the site of pUCL detachment.
Bone bruise with osteoedema at the ulnar sesamoid.
Moderate osteoarthrosis and penetrating chondromalacia at the thumb MCP and IP joints.
TENDONS: The adductor pollicis tendon lies deep to the displaced and detached pUCL . The extensor pollicis longus and brevis and flexor pollicis longus are intact.
GENERAL: Thumb carpometacarpal joint capsulitis and periarticular soft tissue swelling
Impressions
1. Full-thickness tear of the left thumb proper ulnar collateral ligament (pUCL) with detachment from its insertion at the volar ulnar aspect of the proximal phalanx. The ligament remains attached at its insertion on the ulnar volar aspect of the thumb metacarpal head but projects superficial to the adductor pollicis tendon insertion. The accessory ulnar collateral ligament (aUCL) remains attached at the ulnar sesamoid and volar plate. Findings compatible with a Stener lesion. Consider a hand surgery consultation.
2. Mild radial subluxation of the thumb proximal phalangeal base.
3. Bone bruise at the ulnar sesamoid.
