Jiang Eric X, Korn Michael A, King Elizabeth A, van Holsbeeck Marnix
Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
Department of Musculoskeletal Radiology, Henry Ford Hospital, Detroit, MI, USA.
Ultrasound. 2022 Nov;30(4):323-327. doi: 10.1177/1742271X211055844. Epub 2021 Nov 16.
Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging.
We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury.
This particular injury pattern has not been reported in the literature previously and likely explains the patient's lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury.
We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments.
指侧副韧带损伤是常见的手部损伤，可导致明显疼痛和功能障碍。超声检查在评估这些韧带损伤方面可能有用，因为它既经济有效，又能在成像过程中进行简便的动态评估。
我们报告了一例罕见的超声检查发现，即食指桡侧副韧带损伤，发现韧带的一个瓣片被困在掌指关节内，据我们所知，此前尚未有过相关描述。我们将这一发现与侧副韧带卡压的术中图像进行了关联。我们还报告了超微血管成像在辅助诊断指侧副韧带损伤中的新应用。
这种特殊的损伤模式此前在文献中未见报道，这可能解释了患者非手术治疗效果不佳的原因。我们的发现类似于拇指尺侧副韧带损伤中所见的斯滕纳（Stener）病变，即韧带因卡压而无法愈合。此外，通过使用超微血管成像（SMI），我们能够观察到周围结构和韧带本身的充血情况，提示存在急性损伤。
我们预计本病例报告将为超声检查人员提供有关指侧副韧带这种特定损伤模式的知识和图像。
