GAMEKEEPER THUMB - DIAGNOSIS OF ULNAR COLLATERAL LIGAMENT INJURY USING MAGNETIC-RESONANCE-IMAGING, MAGNETIC-RESONANCE ARTHROGRAPHY AND STRESS RADIOGRAPHY

Ulnar collateral ligament (UCL) tears may be nondisplaced or displaced relative to the adductor pollicis aponeurosis, Nondisplaced tears typ ically heal with immobilization whereas displaced tears require surger y. Nineteen patients with UCL injuries were evaluated using MR imaging (MRI), MR arthrography, and stress radiography (SR) to determine the efficacy of these techniques in differentiating nondisplaced from disp laced UCL tears, Nineteen patients with UCL injuries were evaluated. M RI was utilized in 5 patients, and MR arthrography in 14, with 12 of t hese 14 undergoing SR. They were followed until resolution of symptoms ; those without relief, and those with suspected displaced UCL tears w ere surgically explored. Surgery and imaging was correlated, Eight pat ients underwent surgical repair. SR was abnormal in six patients treat ed surgically, but was negative in four of six conservatively treated patients with MR findings of nondisplaced tears, All patients with MR or MR arthrographic findings interpreted as being normal or as having a nondisplaced tear improved after conservative treatment, Based on su rgical findings and clinical follow-up, NIR arthrography accurately di agnosed 13 of 14 UCL injuries, with one false-positive interpretation. SR is often falsely negative, MR imaging with or without intra-articu lar contrast injection proved to be accurate in a small series of pati ents with UCL injuries.