Skip to main content
Journal cover image

The influence of thumb metacarpophalangeal joint rotation on the evaluation of ulnar collateral ligament injuries: a biomechanical study in a cadaver model.

Publication ,  Journal Article
Mayer, SW; Ruch, DS; Leversedge, FJ
Published in: J Hand Surg Am
March 2014

PURPOSE: To determine whether variation in thumb metacarpophalangeal (MCP) joint pronosupination influences perceived ulnar collateral ligament (UCL) stability during clinical stress testing. METHODS: Twelve fresh-frozen specimens underwent sequential evaluation for the following conditions: ligament intact (LI), proper UCL deficient (-pUCL), and proper and accessory UCL deficient (UCL). Valgus stress testing was completed in both 0° and 30° MCP joint flexion for thumb pronation, neutral, and supination. RESULTS: Compared with neutral MCP joint rotation, supination decreased and pronation increased stability such that established treatment guidelines could be incorrectly applied. During evaluation in supination and 0° flexion, 9/12 -pUCL had greater than 35° laxity and, similarly, the mean laxity of -pUCL was similar to the UCL group in neutral rotation and 0° flexion, incorrectly suggesting a complete ligament tear. In comparison, mean laxity of the *UCL in pronation and 0° flexion was not different than -pUCL in neutral rotation and 0° flexion, emphasizing the stabilizing effect of pronation. CONCLUSIONS: Thumb MCP joint pronosupination significantly influenced the evaluation of joint stability, where pronation improved valgus stability in contrast to supination that tended to increase joint instability, In pronation and 0° flexion, a complete UCL injury could be misdiagnosed as a partial injury. In supination and 30° flexion, an intact UCL could be misdiagnosed as a partial UCL injury. In supination and 0°, a partial UCL injury could be misdiagnosed as a complete UCL injury. CLINICAL RELEVANCE: Accurate evaluation of thumb UCL stability is critical for guiding treatment. Variations in thumb MCP joint rotation during stress testing may influence clinical interpretation and, therefore, we recommend standardization of testing with the thumb MCP joint in neutral rotation.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Hand Surg Am

DOI

EISSN

1531-6564

Publication Date

March 2014

Volume

39

Issue

3

Start / End Page

474 / 479

Location

United States

Related Subject Headings

  • Supination
  • Stress, Mechanical
  • Rotation
  • Range of Motion, Articular
  • Pronation
  • Orthopedics
  • Metacarpophalangeal Joint
  • Joint Instability
  • Humans
  • Collateral Ligaments
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mayer, S. W., Ruch, D. S., & Leversedge, F. J. (2014). The influence of thumb metacarpophalangeal joint rotation on the evaluation of ulnar collateral ligament injuries: a biomechanical study in a cadaver model. J Hand Surg Am, 39(3), 474–479. https://doi.org/10.1016/j.jhsa.2013.11.044
Mayer, Stephanie W., David S. Ruch, and Fraser J. Leversedge. “The influence of thumb metacarpophalangeal joint rotation on the evaluation of ulnar collateral ligament injuries: a biomechanical study in a cadaver model.J Hand Surg Am 39, no. 3 (March 2014): 474–79. https://doi.org/10.1016/j.jhsa.2013.11.044.
Mayer, Stephanie W., et al. “The influence of thumb metacarpophalangeal joint rotation on the evaluation of ulnar collateral ligament injuries: a biomechanical study in a cadaver model.J Hand Surg Am, vol. 39, no. 3, Mar. 2014, pp. 474–79. Pubmed, doi:10.1016/j.jhsa.2013.11.044.
Journal cover image

Published In

J Hand Surg Am

DOI

EISSN

1531-6564

Publication Date

March 2014

Volume

39

Issue

3

Start / End Page

474 / 479

Location

United States

Related Subject Headings

  • Supination
  • Stress, Mechanical
  • Rotation
  • Range of Motion, Articular
  • Pronation
  • Orthopedics
  • Metacarpophalangeal Joint
  • Joint Instability
  • Humans
  • Collateral Ligaments