CLINICAL AND IMAGING CORRELATION IN RECENT THUM ULNAR COLLATERAL LIGAMENT TEAR

Abstract

In this study we had tried to explore the obscure nature of UCL injuries of the thumb MP joint. The reported poor results of closed treatment of acute injury of UCL, had led many in favour of surgical repair of the torn ligament.

The UCL displacement from underneath the adductor aponeurosis was assumed to be the cause behind closed treatment failure, (Stener's assumption). Recently US was introduced as a new method for diagnosis of UCL displacement. We had explored the different methods of diagnosis, the clinical and the imaging methods, including that of U. S . The results of these methods were assessed by surgical exploration .

Nineteen patients with recent tear of UCL of the thumb were examined clinically by history taking and by physical examination of MP joint. Then the patients were examined by two different methods of imaging techniques, stress radiographic films and ultra sonographic studies .

Those patients proved by clinical and imaging examination to have complete tear of UCL were went for surgical repair of the ligament. The pre-operative diagnosis were assessed by operative findings .On the other hand patients with partial tears of the ligament or who refused surgical treatment went for closed treatment by glove spica for 3-4 weeks .

All patients had average follow up period of ten weeks . The results of treatment policy were estimated subjectively by recording the state of pain and strength of the MP joint and by objective measurements of ROM of both MP and IP joints, also by testing the MP joint stability. The results of the study was found as follows :

I- The stability stress testing of MP joint would accurately establish MP joint instability, and would diagnose complete tear of UCL of the thumb. The MP joint either open or does not open to radial stress , so feeling of a soft end-point is a diagnostic sign of complete tear . This finding was proved by surgical exploration, all cases with suspected complete tear of the ligament by clinical examination were found at surgery to be so. On the other hand we had faced difficulty to assess ligament tear by measuring MP joint angulation. The MP joint was found to have a wide variation in