Utility of MRI for diagnosing complete tears of the collateral ligaments of the metacarpophalangeal joints of the lesser digits

Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients

INTRODUCTION

Collateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically.

METHODS

Twenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar).

RESULTS

Among the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions. Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger. Mean follow-up of the 15 patients reviewed was 24 months (8-56). Mean MP flexion-extension range of motion was 86°/11° (71-99/0-29). Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side. Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°. There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension. The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively -12% and +8%.

CONCLUSION

The postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use.

LEVEL OF EVIDENCE

IV; retrospective study.

The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits’ Proximal Interphalangeal Joints

Background

Collateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits.

Methods

A retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. 

Results

In digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p<0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727).

Conclusion

This study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.

Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy

PURPOSE

This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy.

METHODS

A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared.

RESULTS

Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019).

CONCLUSION

Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update

OBJECTIVE

The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist.

METHODS

Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted.

RESULTS

None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively.

CONCLUSIONS

There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.