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Wk 3, Case 5 - Review

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So this is a 41 year old patient who has pain centered

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at the first metacarpal phalangeal joint following trauma.

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Important concepts here,

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the presence of an injury on the NAR side of the first metacarpal

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phalangeal joint involving both the proper and

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accessory ulnar collateral ligaments.

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We see fluid signal intensity propagating

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between the ulnar tubercle of the

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proximal first feelings, um,

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across the retracted and torn ulnar collateral ligament

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interpose. Between the torn ulnar collateral ligament fibers.

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We see the adductor aosis, which is thicken and emus,

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bringing about the presence of a yoyo cy,

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which is the retracted U C L with the interpose

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OSIS fibers.

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Given this characteristic appearance on Corona images,

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as we follow the injury in the axial plane,

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we can see the retraction and bunching up of the fibers

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at the level of the first metacarpal head.

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So this is dual retracted U C L Interpose

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osis.

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This is an interposition syndrome extended lesion due to a

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full thickness of the ulnar collateral ligament and

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interposition of theosis.

Report

Patient History
41-year-old male with left thumb pain.

Findings

LIGAMENTS: The proper ulnar collateral ligament (UCL) of the left 1st metacarpophalangeal (MCP) joint are torn and detached from their volar attachment near the ulnar tubercle at the 1st phalangeal base distally, thickened and retracted to their origin at the dorsal aspect of the 1st metacarpal head. Interposed within these retracted ligaments, an inflamed adductor aponeurosis is appreciated.

Findings compatible with “yoyo on a string” or “lollipop sign” of a Stener lesion.

OSSEOUS: No macrofracture is identified.

TENDONS: The extensor pollicis longus, extensor pollicis brevis and flexor pollicis longus are intact.

GENERAL: Diffuse soft tissue swelling throughout the thumb, the adductor pollicis muscle and thenar eminence.

Impressions
1.High-grade tear, retracted rupture of the proper ulnar collateral ligaments of the left thumb at their volar attachments in the ulnar tubercle of the 1st phalanx with proximal retraction and an interposed adductor aponeurosis in keeping with a Stener lesion.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Jenny T Bencardino, MD

Vice-Chair, Academic Affairs Department of Radiology

Montefiore Radiology

Todd D. Greenberg, MD

Radiologist

ProScan

Tags

Musculoskeletal (MSK)

MRI

Hand & Wrist