0:00

Over the next hour and 15 minutes

0:02

or so, I'll spend, uh, time talking about Mr.

0:05

Imaging of the fingers

0:06

and thumb, of course designating the difference

0:08

between the two, just because the anatomy is

0:10

so very different from the standpoint of disclosure.

0:14

I have no financial, uh, disclosures with respect

0:16

to this presentation as we approach the topic

0:21

of imaging and pathology considerations of the finger.

0:25

Uh, clearly a knowledge of anatomy is fundamental in

0:28

that i identification of pathology,

0:31

and this is perhaps a mantra, uh,

0:33

that has been instilled into, uh, all

0:36

of the disciples of Dr.

0:38

Donald Resnick, of course, his history with respect

0:42

to research and really understanding anatomy

0:45

and then being able to focus on patterns of pathology,

0:49

something that all of us have taken on

0:51

and I think made us, um, you know, understand

0:54

that pathology at a completely different level.

0:58

So having said that, we'll start

0:59

with the first metacarpal falange joint.

1:01

And as you look at this illustration, you're going

1:04

to be considering this from the standpoint

1:06

of the palmar aspect of the thumb.

1:09

As you look at the blue illustration here, geographic area

1:12

that represents the articular cartilage at the Palmer aspect

1:16

of the metacarpal.

1:18

That cartilage extending approximately

1:21

to accommodate the two sesamoids, radial

1:24

and ulnar at the Palmer aspect of the joint

1:27

between the two sesamoids shown in yellow,

1:30

there's an insam ligament,

1:32

and as we consider the palmar capsular structures

1:36

of the thumb, we have both palmar ulnar

1:40

and palmar radial longitudinal ligaments that shore up

1:44

or reinforce the Palmar capsule.

1:47

As we consider every articulation in the body,

1:50

it's a good idea to have an understanding were you

1:53

to place contrast

1:55

or were this person to have native fluid within

1:57

the articulation.

1:59

What would the distribution of that fluid be in the setting

2:02

of acute and subacute trauma?

2:05

If that distribution doesn't correlate with

2:08

what you know the confines of the capsule to be,

2:11

that's a good secondary finding

2:13

that you've got capsular insufficiency

2:15

or have had a previous injury in that region.

2:19

While we consider ligamentous structures,

2:21

as we assess them on MR as linear, very discreet,

2:25

easily separable one from the other, for any of us

2:29

who remember their surgical rotations

2:31

or have done dissections any in any joint in the body,

2:35

we realize that our partners on the surgical side are doing

2:39

something more like this, where that discreet area

2:43

that we consider a ligamentous structure in many cases

2:46

isn't so discreet.

2:48

And what we're really looking at is something like this,

2:51

a fibrous envelope that really surrounds the articulation,

2:56

making it sometimes difficult to distinguish the

2:59

Ending of one structure

3:00

and the beginning of the next structure.

3:02

So we keep that in mind.

3:05

Now still looking at the palmar aspect

3:07

of the articulation here,

3:09

the first metacarpal phalangeal joint.

3:12

Now we're going to add in the true

3:14

ulnar collateral ligament, of course, at the ulnar aspect of

3:18

that MCP, adding in the complexity

3:22

of the overlying structure of the transverse

3:25

and oblique apo neurosis

3:27

or heads of the adductor apo neurosis.

3:30

Remember that that adductor apo neurosis is gum was going

3:34

to come to life superficial

3:36

to the ulnar collateral ligament.

3:38

Now I'm showing you the dorsal vantage point of

3:41

that metacarpal phal joint.

3:43

You see the muscle at the palmar aspect,

3:46

the apo neurosis here, the sheer light gray color coming

3:50

to attach superficial to the ulnar collateral ligament.

3:54

As most of you are aware,

3:56

we'll be very careful in the assessment of injury

3:59

to determine whether

4:00

or not that relationship of ulnar collateral ligament

4:04

and adductor apo neurosis remains intact.