Limits...
Thumb ultrasound: Technique and pathologies

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

No MeSH data available.


Related in: MedlinePlus

Ulnar collateral ligament tear (A-B). Schematic diagram (A), long axis ultrasound (B) shows intrasubstance reduced tear of the UCL (red arrow) with normally positioned adductor pollicis aponeurosis (blue arrow). Schematic diagram (C) and long axis ultrasound (D) show avulsed UCL with bony fragment (red arrow) and normally positioned adductor pollicis aponeurosis (blue arrow). Magnetic resonance imaging show avulsed UCL (red arrow) on coronal T1 (E) and PD fat-sat (F) images. A small bony defect was noted along the inferomedial aspect of the base proximal phalanx
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5036340&req=5

Figure 15: Ulnar collateral ligament tear (A-B). Schematic diagram (A), long axis ultrasound (B) shows intrasubstance reduced tear of the UCL (red arrow) with normally positioned adductor pollicis aponeurosis (blue arrow). Schematic diagram (C) and long axis ultrasound (D) show avulsed UCL with bony fragment (red arrow) and normally positioned adductor pollicis aponeurosis (blue arrow). Magnetic resonance imaging show avulsed UCL (red arrow) on coronal T1 (E) and PD fat-sat (F) images. A small bony defect was noted along the inferomedial aspect of the base proximal phalanx

Mentions: Ulnar collateral ligament injury is graded into sprain, partial tear, and full thickness tear, and is referred to as the gamekeeper's thumb or skier's thumb.[13] Sprained ligaments appear thickened and hypoechoic owing to edema and hemorrhage, and appears as a thickened heterogeneous ligament with no disruption on dynamic valgus stress. The goal of imaging in tears of the UCL is to determine whether the torn ligament remains reduced [Figure 15A and B] [Video 7] or has displaced proximally. Visualization of an echogenic avulsion fracture fragment [Figure 15C–E] may be a clue to full-thickness tear. Absence of normal UCL fibers and presence of a heterogeneous mass proximal to the metacarpophalengeal joint is 100% accurate when diagnosing a complete UCL rupture.[14] UCL ligament tear can be associated with a Stener's lesion, which occurs when the torn UCL retracts proximally and folds on itself with the adductor aponeurosis interposed between the ruptured UCL and its site of insertion at the base of the proximal phalanx. The ultrasound appearance [Figure 16] of a Stener lesion has been likened to a yo-yo on a string, similar to findings on MRI. The string of the yo-yo represents the adductor pollicis aponeurosis, and the yo-yo represents the balled-up and displaced proximal portion of the ulnar collateral ligament. This precludes successful primary healing since the ruptured ends of the ligament are no longer in contact, resulting in long-term morbidity. Surgical repair is needed to avoid permanent instability and early osteoarthritis.[12]


Thumb ultrasound: Technique and pathologies
Ulnar collateral ligament tear (A-B). Schematic diagram (A), long axis ultrasound (B) shows intrasubstance reduced tear of the UCL (red arrow) with normally positioned adductor pollicis aponeurosis (blue arrow). Schematic diagram (C) and long axis ultrasound (D) show avulsed UCL with bony fragment (red arrow) and normally positioned adductor pollicis aponeurosis (blue arrow). Magnetic resonance imaging show avulsed UCL (red arrow) on coronal T1 (E) and PD fat-sat (F) images. A small bony defect was noted along the inferomedial aspect of the base proximal phalanx
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036340&req=5

Figure 15: Ulnar collateral ligament tear (A-B). Schematic diagram (A), long axis ultrasound (B) shows intrasubstance reduced tear of the UCL (red arrow) with normally positioned adductor pollicis aponeurosis (blue arrow). Schematic diagram (C) and long axis ultrasound (D) show avulsed UCL with bony fragment (red arrow) and normally positioned adductor pollicis aponeurosis (blue arrow). Magnetic resonance imaging show avulsed UCL (red arrow) on coronal T1 (E) and PD fat-sat (F) images. A small bony defect was noted along the inferomedial aspect of the base proximal phalanx
Mentions: Ulnar collateral ligament injury is graded into sprain, partial tear, and full thickness tear, and is referred to as the gamekeeper's thumb or skier's thumb.[13] Sprained ligaments appear thickened and hypoechoic owing to edema and hemorrhage, and appears as a thickened heterogeneous ligament with no disruption on dynamic valgus stress. The goal of imaging in tears of the UCL is to determine whether the torn ligament remains reduced [Figure 15A and B] [Video 7] or has displaced proximally. Visualization of an echogenic avulsion fracture fragment [Figure 15C–E] may be a clue to full-thickness tear. Absence of normal UCL fibers and presence of a heterogeneous mass proximal to the metacarpophalengeal joint is 100% accurate when diagnosing a complete UCL rupture.[14] UCL ligament tear can be associated with a Stener's lesion, which occurs when the torn UCL retracts proximally and folds on itself with the adductor aponeurosis interposed between the ruptured UCL and its site of insertion at the base of the proximal phalanx. The ultrasound appearance [Figure 16] of a Stener lesion has been likened to a yo-yo on a string, similar to findings on MRI. The string of the yo-yo represents the adductor pollicis aponeurosis, and the yo-yo represents the balled-up and displaced proximal portion of the ulnar collateral ligament. This precludes successful primary healing since the ruptured ends of the ligament are no longer in contact, resulting in long-term morbidity. Surgical repair is needed to avoid permanent instability and early osteoarthritis.[12]

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.

No MeSH data available.


Related in: MedlinePlus