radial collateral ligament wrist injury treatment

The usual injury mechanism is radial deviation of the thumb, commonly caused by falling on the hand while holding a ski pole. Ulnar and radial collateral ligament injuries are common in athletics. Figure 17b. Although a consensus has emerged that favors the nonsurgical treatment of undisplaced fractures The lateral slips are supplemented by fibers from the adjacent lumbrical and interosseous muscles to form the conjoint tendons. These are often contact injuries, but not always. (a) Lateral radiograph of the ring finger shows a small avulsion fracture fragment at the terminal extensor tendon insertion on the dorsal base of the distal phalanx (arrowhead) with slight DIP joint flexion. We have divided our discussion of pertinent ligaments of the wrist into several broad catego-ries: the intrinsic ligaments, the volar extrinsic ligaments, the dorsal extrinsic ligaments, and the ligaments of the thumb. Each joint has an individual capsule, with a complement of supporting structures including ligaments, volar plates, and opposing flexor and extensor tendinous structures (2). Clinically, HADD usually manifests as a monoarticular process in patients 40–70 years old. Florid reactive periostitis is the earliest finding in this spectrum of conditions, whereas bizarre parosteal osteochondromatous proliferation (also called a Nora lesion) (Fig 21) is of intermediate chronicity, and turret exostosis (Fig 22) is more chronic. Imaging findings favoring an ossicle over an acute fracture include rounded well-corticated margins of the ossicle and adjacent bones, a lack of associated point tenderness at the location of the ossicle, and identification of similar findings at the contralateral wrist (89). RCL Injury. In 1955, Campbell 1 described the clinical signs and symptoms of ulnar collateral ligament insufficiency of the metacarpophalangeal (MCP) joint of the thumb, calling it “gamekeeper's thumb” because it was a frequent occupational injury of Scottish gamekeepers. A TFCC injury can be a very disabling wrist condition. The thumb RCL arises dorsally from the condyle of the metacarpal head, courses obliquely, and inserts distally and volarly at the proximal phalanx tubercle (24). It is an excellent tool that can evaluate for intraarticular involvement, radial collateral ligament competency, and definition of the degree of tearing of the extensor origin. Radiographs are typically sufficient for characterization of mallet finger injuries, although US or MRI can be useful in determining the extent of tendon retraction and the state of the avulsed tendon (43). Figure 21. The terminal tendon ultimately inserts on the dorsal base of the distal phalanx (40). An intact dorsal central ligament (black arrowhead in a and b) attaches to the first metacarpal base. fractures and ligament injuries. (b, c) Sagittal CT images (bone [b] and soft-tissue [c] windows) show the fracture fragment (white arrowhead in b and c) attaching to the ECRL tendon (black arrowheads in c), with resultant proximal fracture fragment displacement. (c) Sagittal CT image (soft-tissue window) shows the distal-most segment of the ECRB tendon (arrowhead) inserting on the third metacarpal base fracture fragment. Bone marrow edema is present (white arrowhead in a and c) at the base of the thumb metacarpal, which is concerning for a small underlying avulsion fracture. Identification. Coronal proton-density–weighted fat-suppressed (a), sagittal T2-weighted fat-suppressed (b), and axial proton-density–weighted fat-suppressed (c) MR images through the thumb base show increased amorphous high signal intensity and attenuating fiber of the volar-ulnar attachment of the anterior oblique ligament (arrows), which is consistent with a partial ligament tear. This type of fracture occurs with an axial load to the fifth metacarpal in combination with traction forces from tendon attachments and typically results in a two-part intra-articular fracture at the metacarpal base (20). The most frequent site of injury is at the attachment of the ligament to the proximal phalanx bone, and a bony avulsion occurs in approximately 50% of injuries (5). Radiographic evaluation should include determining whether the injury involves an isolated tendon avulsion (ie, flexion of the DIP without an associated fracture) or an avulsed bony fragment. When the thumb is injured, immediate pain and swelling follow. Surgical treatment may be pursued in patients with chronic injuries, with the goal of improving range of motion and decreasing pain (60,61). Historically, the anterior oblique ligament was considered the most important stabilizer (7). (c) Coronal T2-weighted fat-suppressed MR image in a 64-year-old man after a bicycle crash shows a Stener lesion with a UCL injury and retraction of an avulsed bone fragment (white arrowheads), which is separated from the donor site on the proximal phalanx (*) by the interposed adductor pollicis (black arrowheads). (a) Oblique radiograph of the thumb shows an ovoid amorphous calcification (arrowhead) along the ulnar aspect of the thumb MCP joint, near the expected location of the UCL. The wrist may also look bruised or discolored, and feel painful for several weeks. (b) Axial proton-density–weighted fat-suppressed MR image at the same level shows the lunate fracture fragment (arrowhead) attached to an intact SLL (*). Figure 18a. (b) Coronal proton-density–weighted fat-suppressed MR image in a 42-year-old woman after an acute thumb injury shows full-thickness disruption of the UCL (white arrowhead), with fluid signal intensity undermining its proximal phalangeal attachment. The ligament may tear at the midsubstance or at the metacarpal or proximal phalanx attachment, with the proximal tear being most common (26–28). SLL avulsion in a 53-year-old man after a fall onto an outstretched hand. Bennett fracture in a 45-year-old woman with thumb pain after a fall. A ligament is connective tissue that connects bone to bone across a joint to help stabilize that area of the joint against excessive forces. The remainder of patients are treated surgically, including patients with marked joint subluxation and intra-articular volar plate interposition (43). Radiographic findings of jersey finger include mild hyperextension of the DIP and soft-tissue swelling, because most injuries are tendon avulsions without an associated fracture. Pathomechanics and treatment options, Dorsal scapholunate ligament injury: a classification of clinical forms, Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study, Incidence of dorsal radiocarpal ligament tears in the presence of other intercarpal derangements, Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate, The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis, Scapholunate ligament injuries: a review of current concepts, Treatment of scapholunate ligament injury: Current concepts, Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Lateral radiograph through the hand shows a well-corticated ossific body interposed between the dorsal aspect of the long and index finger metacarpal bases (arrow), which is a finding that is in keeping with an os styloideum. The ligaments of the wrist not only attach the carpal bones to one another, but they connect the carpals to the radius and ulna, as well as, to the metacarpal bones. An injury to even one of these many ligaments affects the way the bones are able to move together. Radial collateral ligament injuries occur as a result of a forced adduction moment on the MCP joint of the thumb, which may occur from a fall on the radial aspect of the thumb and hand or during sports when a ball or player strikes the thumb. Surgical Treatment. This mechanism of injury was originally called a ring avulsion because of its occurrence in patients who catch their wedding band on moving machinery or a protruding object (51). Treatment for grade 3 RCL tears is controversial, although more recent literature favors surgical fixation. Bizarre parosteal osteochondromatous proliferation preferentially affects the metacarpal and metatarsal bones and is located more frequently in the hand than in the foot (92–94). Injury severity may be underestimated because of underlying long-segment neurovascular injury from crushing, shearing, and avulsion. Some of the most common types of injuries of the hand and wrist are ligament injuries. ECRB avulsion fracture in a 37-year-old man with radial-sided hand pain after a motor vehicle collision (same patient as in Fig 16). Replantation is frequently reserved for injuries occurring distal to the flexor digitorum superficialis insertion, and the avulsed FDP tendon is often resected before replantation (55,56). The dorsal and volar radioulnar ligaments, which are major stabilizers of the DRUJ, attach to the base of the ulnar styloid and the fovea. Radiographically, the calcium deposits may be ill-defined in the early stages but become more homogeneously attenuating over time. The volar plate attaches to the periosteum of the head of the proximal phalanx and the periosteum of the base of the middle phalanx and is held in place laterally by the accessory collateral ligaments (58). Figure 9. (b) Coronal proton-density–weighted fat-suppressed MR image through the thumb MCP joint in a 41-year-old woman with a history of thumb injury and pain shows a partial-thickness tear of the RCL (arrowhead) from its phalangeal attachment, without an associated avulsion fracture. Because of the relatively stable nature of these fractures, conservative management may be acceptable. Some authors argue that controlled stress is unlikely to cause further injury, while others assert that there is at least some risk of completing a previously nondisplaced ligament tear (21). Because the thumb provides nearly 40% of hand function (5), accurate identification and description of these injuries is important to ensure optimal treatment. Mallet finger usually is caused by an object (e.g., a ball) striking the finger, creating a forceful flexion of an extended DIP. The findings helped confirm avulsion fracture from the second metacarpal base. Hand therapy is often incorporated as part of the recovery process to ensure proper joint alignment and function recovery during healing. The thumb can be injured from a fall, especially on a ski pole, thus earning it the name skier’s thumb. The volar plate maintains the anterior and posterior stability of the PIP joint and prevents hyperextension. Taleisnik originally described the thickening of the external surface of the lateral-palmer part of the capsule of the wrist as the radial collateral ligament (Figure 7-10). The goals for hand therapy following a CMC arthroplasty are to regain thumb / wrist range of motion, decrease pain, increase functional strength and return to functional ... Continue with hand therapy to emphasize wrist strengthening with 1 … DeLee and Drez’s orthopaedic sports medicine: principles and practice. Radial styloid fractures may also occur because of direct impact on the dorsal aspect of the wrist, termed the chauffeur fracture, and may have a similar imaging appearance. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation, Bizarre parosteal osteochondromatous proliferation (Nora’s lesion): a retrospective study of 12 cases, 2 arising in long bones, Florid reactive periostitis and bizarre parosteal osteochondromatous proliferation: pre-biopsy imaging evolution, treatment and outcome, MR imaging features of bizarre parosteal osteochondromatous proliferation of bone (Nora’s lesion), Open in Image The findings helped confirm avulsion fracture from the second metacarpal base. method:1. This strong band of tissue is attached to the middle joint of the thumb, the joint next to the web space of the thumb. Volar plate avulsions are treated conservatively, with extension-block splinting when the fracture involves less than 40% of the articular surface and is easily reducible (43). For chronic injuries that are unresponsive to splinting, fracture fragments comprising more than one-third of the joint surface, or fragment displacement of greater than 3 mm, surgical fixation is often considered, although some data suggest that surgical treatment does not result in better functional outcomes (44). The manifestation can be similar to that of an infectious process such as a septic joint, but normal laboratory values including leukocyte count and erythrocyte sedimentation rate allow differentiation (84). Severe pain with tuning-fork application over the radial collateral ligament injury in 53-year-old. After the initial imaging manifestation the MRI appearance of these benign radial collateral ligament wrist injury treatment is nonspecific and,... To stabilization journal of hand and shoulder ( 82 ) level of the wrist anatomy is crucial recognizing... Resulting in instability, accompanied by pain and friction in the ulnar head slid palmarly the... 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