Download PDF
Semin Musculoskelet Radiol 2012; 16(04): 338-350
DOI: 10.1055/s-0032-1327007
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Athlete's Hand: Ligament and Tendon Injury

Luke R. Scalcione
1   Department of Medical Imaging, University of Arizona Medical Center, Tucson, Arizona
,
Mini N. Pathria
2   Department of Radiology, University of California San Diego Medical Center, San Diego California
,
Christine B. Chung
2   Department of Radiology, University of California San Diego Medical Center, San Diego California
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Hand injuries are common, accounting for up to 20% of emergency department visits nationwide. An understanding of the complex and detailed anatomical relationships of small joints facilitates the accurate diagnosis of many common sports-related injuries of the hand. We review the common ligamentous and tendinous injuries of the hand including collateral ligament injuries, gamekeeper's thumb, extensor mechanism injuries, pulley injuries, boutonniere deformities, and mallet and jersey lesions. The mechanism of injury, clinical presentation and treatment, pertinent anatomy, and imaging findings are discussed.

Keywords

hand - tendons - ligaments - Stener lesion - gamekeeper's thumb - ulnar collateral ligament - radial collateral ligament - extensor mechanism - palmar plate - boutonniere deformity - mallet finger - jersey finger
 

  • References

  • 1 Jarvik JG, Dalinka MK, Kneeland JB. Hand injuries in adults. Semin Roentgenol 1991; 26 (4) 282-299
    CrossrefPubMedGoogle Scholar
  • 2 Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br 1955; 37-B (1) 148-149
    CrossrefPubMedGoogle Scholar
  • 3 Tang P. Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg 2011; 19 (5) 287-296
    PubMedGoogle Scholar
  • 4 Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med 2010; 20 (2) 106-112
    CrossrefPubMedGoogle Scholar
  • 5 Ishizuki M, Sugihara T, Wakabayashi Y, Shirasaka R, Aoyama H. Stener-like lesions of collateral ligament ruptures of the metacarpophalangeal joint of the finger. J Orthop Sci 2009; 14 (2) 150-154
    CrossrefPubMedGoogle Scholar
  • 6 Campbell JD, Feagin JA, King P, Lambert KL, Cunningham R. Ulnar collateral ligament injury of the thumb. Treatment with glove spica cast. Am J Sports Med 1992; 20 (1) 29-30
    CrossrefPubMedGoogle Scholar
  • 7 Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb: a clinical and anatomical study. J Bone Joint Surg Br 1962; 44B: 869-879
    PubMedGoogle Scholar
  • 8 Haramati N, Hiller N, Dowdle J , et al. MRI of the Stener lesion. Skeletal Radiol 1995; 24 (7) 515-518
    PubMedGoogle Scholar
  • 9 Clavero JA, Golanó P, Fariñas O, Alomar X, Monill JM, Esplugas M. Extensor mechanism of the fingers: MR imaging-anatomic correlation. Radiographics 2003; 23 (3) 593-611
    CrossrefPubMedGoogle Scholar
  • 10 Thirkannad S, Wolff TW. The “two fleck sign” for an occult Stener lesion. J Hand Surg Eur Vol 2008; 33 (2) 208-211
    PubMedGoogle Scholar
  • 11 Shinohara T, Horii E, Majima M , et al. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound 2007; 35 (2) 73-77
    CrossrefPubMedGoogle Scholar
  • 12 Ebrahim FS, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA. US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics 2006; 26 (4) 1007-1020
    CrossrefPubMedGoogle Scholar
  • 13 Delaere OP, Suttor PM, Degolla R, Leach R, Pieret PJ. Early surgical treatment for collateral ligament rupture of metacarpophalangeal joints of the fingers. J Hand Surg Am 2003; 28 (2) 309-315
    CrossrefPubMedGoogle Scholar
  • 14 Kang L, Rosen A, Potter HG, Weiland AJ. Rupture of the radial collateral ligament of the index metacarpophalangeal joint: diagnosis and surgical treatment. J Hand Surg Am 2007; 32 (6) 789-794
    CrossrefPubMedGoogle Scholar
  • 15 Isani A, Melone Jr CP. Ligamentous injuries of the hand in athletes. Clin Sports Med 1986; 5 (4) 757-772
    PubMedGoogle Scholar
  • 16 Heyman P. Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg 1997; 5 (4) 224-229
    PubMedGoogle Scholar
  • 17 Pfirrmann CW, Theumann NH, Botte MJ, Drapé JL, Trudell DJ, Resnick D. MR imaging of the metacarpophalangeal joints of the fingers: part II. Detection of simulated injuries in cadavers. Radiology 2002; 222 (2) 447-452
    CrossrefPubMedGoogle Scholar
  • 18 Rayan GM, Murray D, Chung KW, Rohrer M. The extensor retinacular system at the metacarpophalangeal joint. Anatomical and histological study. J Hand Surg [Br] 1997; 22 (5) 585-590
    PubMedGoogle Scholar
  • 19 Lisle DA, Shepherd GJ, Cowderoy GA, O'Connell PT. MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am 2009; 17 (4) 639-654 , vi
    CrossrefPubMedGoogle Scholar
  • 20 Lopez-Ben R, Lee DH, Nicolodi DJ. Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US—report of three cases. Radiology 2003; 228 (3) 642-646
    CrossrefPubMedGoogle Scholar
  • 21 Kang L, Carlson MG. Extensor tendon centralization at the metacarpophalangeal joint: surgical technique. J Hand Surg Am 2010; 35 (7) 1194-1197
    CrossrefPubMedGoogle Scholar
  • 22 Kubiak EN, Klugman JA, Bosco JA. Hand injuries in rock climbers. Bull NYU Hosp Jt Dis 2006; 64 (3–4) 172-177
    PubMedGoogle Scholar
  • 23 Clark TA, Skeete K, Amadio PC. Flexor tendon pulley reconstruction. J Hand Surg Am 2010; 35 (10) 1685-1689
    CrossrefPubMedGoogle Scholar
  • 24 Hauger O, Chung CB, Lektrakul N , et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 2000; 217 (1) 201-212
    PubMedGoogle Scholar
  • 25 Kozin SH, Nissenbaum M, Berlet AC. Surgical treatment of boutonniere deformity. Oper Tech Orthop 1993; 3: 313-317
    CrossrefPubMedGoogle Scholar
  • 26 Williams K, Terrono AL. Treatment of boutonniere finger deformity in rheumatoid arthritis. J Hand Surg Am 2011; 36 (8) 1388-1393
    CrossrefPubMedGoogle Scholar
  • 27 Clavero JA, Alomar X, Monill JM , et al. MR imaging of ligament and tendon injuries of the fingers. Radiographics 2002; 22 (2) 237-256
    CrossrefPubMedGoogle Scholar
  • 28 Doyle JR. Extensor tendons: acute injuries. In: Green DP, Hotchkiss RN, Pederson WC, , eds. Green's Operative Hand Surgery. 4th ed. New York, NY: Churchill Livingstone; 1999: 1962-1987
    Google Scholar
  • 29 Smit JM, Beets MR, Zeebregts CJ, Rood A, Welters CF. Treatment options for mallet finger: a review. Plast Reconstr Surg 2010; 126 (5) 1624-1629
    PubMedGoogle Scholar
  • 30 Schweitzer TP, Rayan GM. The terminal tendon of the digital extensor mechanism: Part II, kinematic study. J Hand Surg Am 2004; 29 (5) 903-908
    CrossrefPubMedGoogle Scholar
  • 31 Leinberry C. Mallet finger injuries. J Hand Surg Am 2009; 34 (9) 1715-1717
    CrossrefPubMedGoogle Scholar
  • 32 Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med 2008; 1 (2) 97-102
    CrossrefPubMedGoogle Scholar
  • 33 Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg 2011; 19 (3) 152-162
    PubMedGoogle Scholar
  • 34 de Gautard G, de Gautard R, Celi J, Jacquemoud G, Bianchi S. Sonography of Jersey finger. J Ultrasound Med 2009; 28 (3) 389-392
    PubMedGoogle Scholar
  • 35 Henry SL, Katz MA, Green DP. Type IV FDP avulsion: lessons learned clinically and through review of the literature. Hand (NY) 2009; 4 (4) 357-361
    CrossrefPubMedGoogle Scholar
  • 36 Stewart DA, Smitham PJ, Gianoutsos MP, Walsh WR. Biomechanical influence of the vincula tendinum on digital motion after isolated flexor tendon injury: a cadaveric study. J Hand Surg Am 2007; 32 (8) 1190-1194
    CrossrefPubMedGoogle Scholar