US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis1

doi:10.1148/rg.264055117

US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis1

Farhad S. Ebrahim, MD,
Michel De Maeseneer, MD, PhD,
Tjeerd Jager, MD,
Stefaan Marcelis, MD,
David A. Jamadar, MB, BS, FRCS, DMRD and
Jon A. Jacobson, MD

¹From the Department of Radiology, University of Michigan Health System, Taubman/B-1/Room 132, Box 0302, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0302 (F.S.E., M.D.M., D.A.J., J.A.J.); the Department of Radiology, Aalsters Stedelijk Ziekenhuis, Aalst, Belgium (T.J.); and the Department of Radiology, University of Lie`ge, Lie`ge, Belgium (S.M.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received May 12, 2005; revision requested June 13 and received September 15; accepted September 16. All authors have no financial relationships to disclose.

Address correspondence to
F.S.E. (e-mail: febrahim{at}umich.edu).

Abstract

The thumb is a central component supporting the intricate movements of the hand. Patients with acute thumb pain, particularly after trauma, require prompt evaluation of structural integrity, thus avoiding long-term morbidity such as instability, chronic pain, and osteoarthritis. Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate. US is more dynamic and less time-consuming and may be easier to perform. Furthermore, other disorders such as tenosynovitis, tendon tears, and articular pathologic conditions can involve the thumb and thenar region and may also be diagnosed with US. In this context, US is an underused tool because it is potentially an adjunct to the clinical examination in the appropriate setting. A sound knowledge of the regional anatomy and basic training in the principles of US should equip the imager with the skills necessary to evaluate the UCL of the thumb and its surrounding structures.