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PubMed1988

Clinical, radiographic, and scintigraphic findings associated with enthesitis of the lateral collateral ligaments of the tarsocrural joint in standardbred racehorses.

Injury of the lateral collateral ligaments of the tarsocrural joints was diagnosed in nine Standardbred pacers. The average age was 4.9 years. The severity of the lameness varied from severe to subtle and joint effusion was seen in eight of 10 tarsocrural joints. A positive hindlimb flexion test was seen in four of six cases in which results were recorded. The identification of the site of involvement was based on a focal intense 'hot spot' seen on scintigraphy, and new bone formation seen radiographically at the anatomical sites of insertion of the long lateral collateral ligament of the tarsocrural joint in nine limbs and the short lateral collateral ligament of one limb. The authors believe this injury to be enthesitis caused by the cyclic trauma of training and racing speed. The primary therapy was rest. Of six cases which returned to training, three raced as well or better than before injury.

Animals↗
PubMed2006

Radial collateral ligament repair of the thumb metacarpophalangeal joint using the abductor pollicis brevis tendon.

BACKGROUND: Injuries to the radial collateral ligament of the thumb metacarpophalangeal joint are less common than injuries to the ulnar side. Therefore, published data on this subject are scarce. An innovative method of radial collateral ligament repair is hereby presented, placing emphasis on the long-term results. This technically simple method was developed to allow for a biological joint stabilization based on functional and anatomical considerations. The key concept is to reestablish joint stability by spanning the tendinous portion of the insertion of the abductor pollicis brevis over the radial side of the metacarpophalangeal joint. METHODS: Nine patients with rupture of the radial collateral ligament were treated by means of the abductor pollicis brevis-plasty. All patients suffered from subacute or chronic radial ligament insufficiency. To determine the subjective results of the repair, a score was developed grading the patient's ranking of the results achieved by the abductor pollicis brevis-plasty. All patients graded the results on a scale from 1 (excellent) to 6 (unacceptable). RESULTS: Patients were operated on 37.1 +/- 14.6 days after trauma. Long-term examination was performed after 39 +/- 14.5 months. The patients showed a high satisfaction score of 1.7 +/- 0.5, with good mobility of the metacarpophalangeal I joint (range of motion, 52.2 +/- 6.7 degrees). CONCLUSION: Favorable results suggest that the abductor pollicis brevis-plasty is a suitable, safe, and technically feasible procedure for the operative treatment of chronic instability of the thumb metacarpophalangeal joint after radial hyperadduction trauma and complete rupture or deinsertion of the radial collateral ligament.

Adolescent↗
PubMedDate not supplied

[Rupture of the ulnar, collateral ligament of the metacarpophalangeal joint of the thumb, so-called 'wobbly thumb'].

A stable metacarpophalangeal joint of the thumb is indispensable for a normal grip function of the hand. The joint is stabilized by collateral ligaments. A rupture of the ulnar, collateral ligament is often caused by a sports trauma, as indicated by the denominations "skiërs duim", "goalkeeper's thumb" and "baseball thumb". Many surgeons are not familiar with the phenomenon of an insufficient collateral ligament, also called "wackeldaum". In the period 1981-1985 a consecutive series of 35 patients with a ruptured ulnar collateral ligament was operated in the De Wever hospital Heerlen (Netherlands). On the basis of our own patients, attention is given to the diagnosis, therapy and results of the operative treatment of these lesions.

Adolescent↗
PubMed2000

Thumb collateral ligament injuries. An anatomic basis for treatment.

This anatomic and clinical study leads to the following conclusions: 1. The ulnar and radial proper collateral ligaments are the critical lateral stabilizers of the thumb MP joint; both are highly vulnerable to complete disruption, with resultant disabling joint instability. 2. The intrinsic anatomy of the radial side of the MP joint is not a mirror image of the ulnar aspect. Significant anatomic differences account for distinctive patterns of instability. Whereas disruption of the ulnar collateral ligament in conjunction with dorsal capsular tears is apt to result in combined radiovolar subluxation, disruption of the radial collateral ligament, coupled with the unopposed dynamic force of the adductor pollicis, characteristically is prone to a rapid pathologic sequence of profound joint instability, with progressive ulnar and volar subluxation and, ultimately, degenerative joint disease. 3. Optimal management of the complete collateral ligament lesion requires prompt diagnosis, most accurately confirmed with physical and radiographic stress testing, and precise surgical repair. Immobilization alone is insufficient treatment for these serious ligament disruptions, characterized by considerable displacement with wide separation of torn ends. 4. Although early direct repair affords the best opportunity for restoration of joint integrity with a highly favorable functional recovery, secondary repair and free tendon grafting, prior to joint deformity, provide consistently successful options for chronic instability.

Athletic Injuries↗
PubMedDate not supplied

Injury of the collateral ligaments of the distal interphalangeal joint diagnosed by magnetic resonance.

We describe the clinical, imaging, and necropsy findings of two horses with severe injury of the collateral ligaments of the distal interphalangeal (DIP) joint diagnosed using magnetic resonance (MR) imaging. In MR images it was possible to examine the collateral ligaments of the DIP joint from the origin at the middle phalanx to the insertion on the distal phalanx. Both horses in this report had abnormal high signal intensity within the collateral ligaments of the DIP joint, and one horse had abnormal high signal intensity within the bone of the distal phalanx on short tau inversion recovery (STIR) and T2-weighted imaging sequences. High signal intensity on STIR and T2-weighted images represents abnormal fluid accumulation indicative of inflammation, within ligament, tendon, or bone on these imaging sequences. Abnormalities were confirmed on necropsy in both horses. Injury of the collateral ligaments of the DIP joint should be considered as a source of pain in horses with lameness localized to the foot.

Animals↗
PubMed1984

Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

Animals↗
PubMed2000

Heterotopic calcification and tears of the ulnar collateral ligament: radiographic and MR imaging findings.

OBJECTIVE: The purpose of this paper is to describe the radiographic and MR imaging appearance of heterotopic calcification in the ulnar collateral ligament. MATERIALS AND METHODS: Retrospective radiographic review of 710 patients examined for elbow pain yielded 42 individuals (age range, 16-38 years) with heterotopic calcification in the ulnar collateral ligament. Radiographic and MR imaging findings were compared with surgical findings. RESULTS: Fifty-one heterotopic calcifications were identified in 42 patients; nine patients had two sites of heterotopic calcification. Average initial calcification size in the craniocaudal dimension was 4 mm (range, 1-12 mm) and in the transverse dimension was 1 mm (range, 1-4 mm). Five of 42 patients had enlargement of the calcification on follow-up radiography. The largest heterotopic calcification that was not visualized on MR imaging measured 5 x 4 mm in craniocaudal and transverse dimensions. Of 34 patients with heterotopic calcification who underwent surgery, 26 patients (76%) had either partial or complete tears of the ulnar collateral ligament. CONCLUSION: Heterotopic calcification in the ulnar collateral ligament may be associated with partial or complete tears. The MR imaging detection of heterotopic calcification is less sensitive than that of radiography of the elbow.

Adolescent↗
PubMedDate not supplied

[Value of ultrasound examination in lesion of the medial collateral ligament of the knee joint].

AIM: The present prospective clinical study investigates the value of ultrasonic examination of injuries of the medial collateral ligament of the knee. METHOD: The sonographical examination was done in a real-time method with an ultrasound unit Type AI 3200 (Dornier, Neufahrn, Germany) and with a linear transducer (frequency 7.5 Mhz). This functional measurement is being performed in neutral position and in valgus stress on both knee joints to verify the opening of the medial joint space. 42 patients who have been suspicious for a lesion of the medial collateral ligament of the knee were compared with 80 healthy persons. RESULTS: The average medial opening of the medial joint space in the patient group using manual dynamic ultrasonic examination was 4.4 mm +/- 1.1 mm (2.5-8.0) applying the force manual and 4.0 mm 1.0 mm (1.3 mm-8.0) using the Telos fixation device to apply the stress force. The control group showed an average medial opening of 2.2 mm +/- 0.5 (0-0.5) as stress was applied manual and 2.5 mm +/- 0.7 mm (0-0.4) with the apparative stress examination using the Telos fixation device. CONCLUSION: The ultrasonic verification of the stability of the medial collateral ligament complex in the medial longitudinal view using defined bony landmarks is a very reliable method as a diagnostic tool for acute or older lesions of the medial collateral ligament of the knee. CLINICAL RELEVANCE: The advantages of the ultrasonic examination are the immediate availability, the avoidance of radiation and the visualization of movements with dynamic examinations. In contrast to X-ray examination the ultrasonic investigation can provide useful additional information on soft tissue structures.

Adolescent↗
PubMed1996

Gamekeeper's thumb: ulnar collateral ligament injury.

Injury to the ulnar collateral ligament of the thumb, once a common chronic occupational injury occurring in British gamekeepers, is now most frequently an acute sports-related injury in skiers, football players and other athletes. Differentiation of complete versus partial tears of the ligament is crucial because the treatment for complete tears is surgical. Radiographic evaluation, while important, has a limited role. Partial ligamentous tears, or those associated with uncomplicated avulsion fractures of the proximal phalanx, can be adequately treated by the family physician using simple shortarm thumb spica casting.

Adolescent↗
PubMed1988

Surgical reconstruction of a ruptured medial collateral ligament in a foal.

An avulsed carpal medial collateral ligament was diagnosed by clinical and radiographic examination in a 1-day-old foal that was unable to bear weight on the affected limb. The foal had a valgus deviation originating at the carpus and medial to lateral instability of the affected carpus. The ligament was reconstructed with screws and suture tape. Surgical reconstruction is a viable alternative to long-term casting or splinting for treatment of a ruptured carpal medial collateral ligament in a foal.

Animals↗
PubMed1989

Magnetic resonance imaging of the collateral ligaments of the thumb.

Injury to the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb can usually be diagnosed on the basis of a combination of history, radiographic examination, and clinical stress testing of the joint when appropriate. Occasionally, when the patient is seen late and the diagnosis is doubtful, stress evaluation may be ill-advised because a nondisplaced ligament may be displaced in the process. We had recent experience with three patients in whom the use of magnetic resonance imaging was helpful in diagnosing a displaced ulnar collateral ligament in two cases, and an intraligamentous injury in the other. These studies were conducted at no charge to the patient as part of institutional investigational research. The current cost of this technology is prohibitive for routine use; however, when it becomes less expensive, it may be helpful as a diagnostic tool.

Adult↗
PubMed2003

Sonography of the medial collateral ligament of the elbow: a study of cadavers and healthy adult male volunteers.

OBJECTIVE: We assessed the ability of high-resolution sonography to reveal the size and echogenicity of the anterior bundle of the normal medial collateral ligament of the elbow in cadavers and uninjured male volunteers. MATERIALS AND METHODS: The anterior bundle of the medial collateral ligament in five cadaveric elbows was imaged and injected with contrast material by experienced musculoskeletal radiologists using a 12-MHz linear array transducer. Immediate ligament dissection was performed. The bilateral ligaments in 30 healthy 21- to 34-year-old male volunteers were imaged with gravitational stress. Of these, five randomly selected subjects also received approximately 5 lb (11.3 kg) of applied stress. RESULTS: Contrast material was injected directly into all five cadaveric ligaments. The anterior bundle of the medial collateral ligament in all 30 asymptomatic male volunteers was hyperechoic in comparison with surrounding muscle and had a fibrillar pattern and fanlike shape. Its mean dimensions were 2.6 +/- 0.31 x 2.2 +/- 0.47 x 4.0 +/- 0.88 mm on the right and 2.6 +/- 0.36 x 2.1 +/- 0.42 x 4.0 +/- 0.86 mm on the left, in longitudinal short, transverse short, and transverse long axes, respectively. Differences in ligament measurements in sidedness, stress application, and hand dominance did not approach statistical (Bonferroni corrected, p > 0.01) or clinical (all differences, <0.2 mm) significance. CONCLUSION: Radiologists can accurately use sonography to identify and measure the size of the anterior bundle of the normal medial collateral ligament of the elbow. These baseline parameters for the normal ligament may prove useful when evaluating the injured ligament.

Adult↗
PubMedDate not supplied

Assessment of thumb positioning in the treatment of ulnar collateral ligament injuries. A laboratory study.

In the treatment of ulnar collateral ligament injuries in the metacarpophalangeal joint of the thumb, a cast or splint is often molded with the thumb and hand positioned so the patient can return quickly to a particular sport or activity. However, it is unknown whether a given position of immobilization or whether an early rehabilitation program will compromise ligament healing by causing undue tension in the ligament. To better define acceptable positions for thumb immobilization and a safe range of motion, this laboratory study measured strain in the ulnar collateral ligament at different degrees of metacarpophalangeal joint flexion. Ligament strain was found to increase with increasing joint flexion; the most significant increases in strain occurred as the joint moved from 0 degree to 25 degrees of flexion, with the dorsal portion of the ligament demonstrating greater strain than the palmar portion. Based on these results, immobilization of the metacarpophalangeal joint in excessive flexion and unrestricted early rehabilitation exercises should be done with caution and guided by the grade of injury or the quality of repair.

Adult↗
PubMedDate not supplied

Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow.

To describe the relationship of the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and flexor carpi ulnaris muscles to the medial collateral ligament at 30 degrees, 90 degrees, and 120 degrees of elbow flexion, we dissected 11 cadaveric specimens. The flexor carpi ulnaris muscle is the predominant musculotendinous unit overlying the medial collateral ligament in the majority of cases and is the only one at 120 degrees of elbow flexion. The flexor digitorum superficialis muscle is the only other significant contributor. The medial collateral ligament is the primary stabilizer of the medial elbow with elbow flexion greater than 30 degrees, as in throwing. The flexor carpi ulnaris muscle, because of its position directly over the medial collateral ligament, and the flexor digitorum superficialis muscle, with its near proximity and relatively large bulk, are the specific muscles best suited to provide medial elbow support. This is especially relevant to overhand throwing athletes who encounter extreme valgus force across the elbow during the cocking and acceleration phases of the throwing motion. Exercise and conditioning of the medial elbow musculature, specifically the flexor digitorum superficialis muscle and the flexor carpi ulnaris muscle, may prevent injury or assist in rehabilitation of medial elbow instability, especially in overhand throwing athletes.

Acceleration↗
PubMed2006

Evolution of the treatment options of ulnar collateral ligament injuries of the elbow.

Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.

Adolescent↗
PubMed1997

Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion.

PURPOSE: To determine the best plane and position of the elbow for optimal visualization of normal and abnormal collateral ligaments with conventional magnetic resonance (MR) imaging and MR arthrography, to determine the normal appearance of the collateral ligaments at MR arthrography and to assess use of MR arthrography in evaluation of collateral ligamentous lesions. MATERIALS AND METHODS: Nine cadaveric elbow specimens were imaged with and without intraarticular administration of gadolinium-containing solution in several planes that were identified as potentially useful in a pilot study in two specimens. MR imaging findings were compared with anatomic findings. RESULTS: Normal and abnormal ligaments were best depicted in a 20 degrees posterior oblique coronal plane in relation to the humeral shaft with the elbows extended and a coronal plane aligned with the humeral shaft with the elbows slightly flexed (20 degrees-30 degrees of flexion). Gadolinium enhancement improved the delineation of normal and abnormal ligaments on T1-weighted images in each case. CONCLUSION: The posterior oblique coronal plane with the elbows extended or the coronal plane aligned with the humeral shaft with the elbows slightly flexed allows accurate assessment of the collateral ligaments. Gadolinium-enhanced MR arthrography of the elbow seems to be a promising technique.

Aged↗
PubMed2006

Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee.

The medial collateral ligament of the knee is unique in that it has shown the capacity to heal with conservative measures. As a result, nonoperative treatment is often successful in returning patients back to previous levels of activity and function. However, specific surgical indications do exist for certain isolated and many combined medial collateral ligament injuries. Strict adherence to both nonoperative and operative principles allows for optimum treatment in most instances.

Acute Disease↗