Li Yueying, Wu Guangzhi, Cui Shusen, Zhang Zhan, Gu Xiaosong
Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin.
Key Laboratory of Neuro regeneration, Ministry of Education and Jiangsu Province, Co-innovation Center of Neuro Regeneration, Nantong University, Nantong, Jiangsu, P.R. China.
Medicine (Baltimore). 2020 May;99(19):e20126. doi: 10.1097/MD.0000000000020126.
Rupture of the radial collateral ligament (RCL) of the index metacarpophalangeal (MCP) joint is mostly related to acute local mechanical causes, which severely affect the stability of the MCP joint. However, few cases of chronic bilateral job-related RCL injury have been reported in the literature. There is no consensus on the knowledge of the disease to date. Here, we present an extremely rare case of chronic bilateral RCL injury.
A 58-year-old female shoemaker presented with chief complaints of swelling and pain in the radial aspect of the MCP joint of bilateral index fingers since 2 years. There was no history of acute RCL injury. The persistent pain was aggravated while gripping, pulling, buttoning, and twisting.
Based on the combination of physical examination, X-ray, and ultrasonic and magnetic resonance imaging, the patient was diagnosed with bilateral tear of the RCLs and joint dislocation of the index MCP joint. Eventually, intra-operative findings confirmed the diagnosis.
The patient underwent bilateral index MCP joint fusion followed by immobilization for 6 weeks. Functional therapy was started after immobilization.
The patient's chief complaints were significantly alleviated after the operation. At the 12-month follow-up, the patient returned to a full level of activity as a shoemaker without any complications.
Compared to acute RCL rupture of the index MCP joint, occupation may play an important role in the diagnosis of chronic RCL rupture of the index MCP joint. Our report will provide more diagnostic and treatment experience to deal with this type of injury.
示指掌指关节桡侧副韧带（RCL）断裂主要与急性局部机械性原因有关，这严重影响掌指关节的稳定性。然而，文献中报道的慢性双侧职业性RCL损伤病例很少。迄今为止，对该疾病的认识尚无共识。在此，我们报告一例极其罕见的慢性双侧RCL损伤病例。
一名58岁的女鞋匠，主诉双侧示指掌指关节桡侧自2年前开始肿胀疼痛。无急性RCL损伤史。抓握、牵拉、扣纽扣和扭转时持续性疼痛加剧。
结合体格检查、X线、超声及磁共振成像，患者被诊断为双侧RCL撕裂及示指掌指关节脱位。最终，术中所见证实了诊断。
患者接受了双侧示指掌指关节融合术，随后固定6周。固定后开始功能治疗。
术后患者的主要症状明显缓解。在12个月的随访中，患者作为鞋匠恢复了完全的活动水平，无任何并发症。
与示指掌指关节急性RCL断裂相比，职业在示指掌指关节慢性RCL断裂的诊断中可能起重要作用。我们的报告将为处理这类损伤提供更多的诊断和治疗经验。
