0:01

So let's look at a few examples

0:03

of anterior oblique ligament abnormality.

0:06

We're looking at it here in the sagittal imaging claim.

0:09

This is a 68-year-old patient who presented with pain,

0:13

and of course, in the vast majority of cases, for all of you

0:16

who look at any significant amount of plain films

0:21

or imaging studies of patients who present with base

0:24

of thumb pain, osteoporosis,

0:26

and degenerative change is very common in this articulation,

0:30

again, because of the very wide range

0:33

of motion that we have here.

0:35

So looking at that CMC sagittal plane, we're not surprised

0:39

to see full thickness chondral loss,

0:41

chondral thinning as well.

0:43

And then as we look at the capsular structures here,

0:46

you can see that chronic appearing tear

0:49

of the deep anterior oblique ligament,

0:52

the intact superficial,

0:54

and here extending in slightly displaced

0:56

by osteophyte formation.

0:58

So at that first CMC, we often encounter large osteophytes.

1:02

We often encounter joint space narrowing.

1:05

Subc chondral sclerosis, we see bodies there.

1:09

Uh, we see fragments, uh,

1:11

and those are our classic minings

1:13

that you're seeing routinely with OA at that first CMC.

1:18

Well, how about the Bennett fracture here on the plain film?

1:22

Classic appearance fracture

1:23

through the articular surface involving the NAR base

1:26

of the metacarpal.

1:28

As you look at the MR images,

1:29

here's the deep anterior oblique

1:32

or be ligament attached to the fracture fragment,

1:35

the superficial component extending and still intact,

1:39

and having that attachment slightly more distal on the

1:42

metacarpal classic appearance.

1:45

Let me show you one more here.

1:47

You can see again the fracture fragment minimally displaced

1:51

at the ulnar base of the metacarpal here.

1:54

Very attenuated, slightly redundant,

1:56

and ul undulating deep a OL, but still intact.

2:00

As you then look for the superficial here,

2:02

you see it intact.

2:03

When I say intact, let me just go back and, and clarify.

2:07

Intact with respect to its attachment, to the fracture

2:11

fragment here, the superficial component extending more dis

2:15

and still attaching at the level of the metacarpal.

2:19

And then you can see the percutaneous pin placement here of

2:22

that fracture fragment, uh,

2:24

placing in an anatomic alignment.

2:27

So really reviewing the soft tissue,

2:31

stabilizing anatomy about that first CMC,

2:35

and important structures for you

2:37

to identify when you're considering injuries, both acute

2:41

as well as chronic degenerative changes.