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The Utility of Ultrasound for Detecting Stener Lesions in Ulnar Collateral Ligament Injuries
Julia C. Ruston, MBBS; Ian Yuen; Jackie Hanna; Robert Pearce; Kate Owers; Alice Bremner-Smith; Gajan Rajeswaran; Maxim Horwitz
Chelsea and Westminster Hospital, London, United Kingdom

Introduction: Ulnar collateral ligament (UCL) injuries of the thumb result in an unstable metacarpophalangeal joint (MCPJ), particularly if the adductor aponeurosis interposes between ends of the ruptured ligament, preventing healing. Such ‘Stener lesions’ are an indication for surgical repair and ultrasound (US) is commonly used to investigate suspected UCL injuries prior to repair. We investigated the accuracy of ultrasound in diagnosis of UCL injuries and also whether a difference in the time between the injury and the scan affected the diagnostic accuracy.

Methods: Patients who underwent UCL repair in our hand surgery department were identified retrospectively and electronic and paper records and imaging reports were reviewed. The time between injury, US and surgery was calculated and the diagnostic accuracy of US was calculated using the surgical findings as the gold standard. The seniority of the radiologist was noted.

Results & Discussion: 82 patients underwent UCL repairs between July 2006 and June 2014, one of which was bilateral. From the data available, time from injury to US ranged from 0 to 124 days (median 4) and time from US to surgery ranged from 0 to 126 days (median 5). The overall diagnostic accuracy of US for diagnosing Stener lesions was 64.4%, which was higher in consultants (76.1%) than non-consultant grade radiologists (62.5%). Overall sensitivity was 82.8% and specificity 64.7%. Consultants were more specific but non-consultants had a higher sensitivity, which reflected perhaps lower confidence in negative diagnoses. Scans performed in under 7 days from the time of injury had an accuracy of 69.0%, whereas those performed at over 1 week had an accuracy of 46%. This may be due to scarring of the tissues in more chronic injuries.

Conclusion: US is a useful adjunct to clinical examination, being inexpensive and non-invasive. Our results suggest that US is useful in diagnosis but is best performed promptly by experienced musculoskeletal radiologists.

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