Ulnar Collateral Ligament (UCL) Dynamic Maneuvers Hand

Which dynamic maneuvers are used to evaluate the ulnar collateral ligament of the thumb?

The #UCL extends between the first metacarpal head and the base of the proximal phalanx in the #thumb. It runs deep to the aponeurosis of the adductor pollicis muscle.

The UCL can be injured by forceful hyperextension or extreme abduction of the thumb.

To #scan this ligament, have the patient grip a rolled up towel and place the #transducer in a coronal plane over the ulnar aspect of the first #metacarpophalangeal_joint to begin evaluation of the UCL.

There are two #dynamic maneuvers of the thumb that should be used when performing an ultrasound of the ulnar collateral ligament:

1️⃣ Valgus stress

First, place the hockey stick transducer long axis to the #ulnar_collateral_ligament on the inside of the #thumb. Do a dynamic evaluation of the UCL by applying gentle #valgus stress to the #MCP_joint.
This maneuver will to show any laxity of the ligament or reveal a #tear within the #ligament by widening the defect, making it easier to visualize.


2️⃣ Passive IP joint flexion

Passive flexion of the interphalangeal #joint should be done to isolate the aponeurosis from the ligament. The adductor pollicis aponeurosis is seen as a thin #hypoechoic line overlying the UCL in the ultrasound image.
When there is a tear in the UCL, the overlying aponeurosis of the adductor pollicis muscle can move into the gap between the UCL and the proximal #phalanx. When this occurs, the fibers of the UCL will not be seen inserting onto the #bone. Displacement of a torn UCL superficial or proximal to the #adductor_aponeurosis is indicative of a #stener_lesion.

#tuesdaytipswithjamie #protip #skillshareteacher #msk #mskultrasound #ultrasoundtech #sonographer #gamekeepersthumb #skiersthumb #handultrasound #sportsmedicine #ortho #handsurgeon #like #share #subscribe