Clinical evaluation vs magnetic resonance imaging of the skier's thumb: A prospective cohort of 30 patients.
BACKGROUND
A skiers thumb, or a partial or complete rupture of the ulnar collateral ligament (UCL) is a clinical diagnosis. Swelling, pain, natural left-right difference and inexperience of a young physician can cause difficulty to correctly diagnose this injury. However, our theory is that any physician, given the correct instructions, should be able to diagnose this injury solely on clinical findings, without the necessity of additional imaging.


METHODS
In a large Dutch teaching hospital, physicians (residents with working experience of 6months-3years) working at the ER received instructions for physical examination. Patients >18 years, with an injury <1 week old, suspected of a true skier's thumb had an MRI reported by two independent radiologists to confirm the diagnosis.


RESULTS
Thirty patients were included. Seven patients had no fixed endpoint (23%), all had a complete ligamentous rupture of the UCL on MRI, of which three patients had a Stener lesion. Fifteen patients (50%) met with the criteria  >35° laxity in extension of MCP/ >20° laxity in 30° flexion of the MCP. Of these, thirteen patients (81%) had a complete rupture (nine Stener lesions (56%)). One patient had a partial injury and one patient had no UCL-injury. Eight patients (27%) had inconclusive results during physical examination. Of these, two had a complete rupture (40%, 1 Stener). Three patients had a partial rupture and three patients had an intact UCL.


CONCLUSIONS
A skier's thumb can be diagnosed by any resident when correctly instructed. Additional imaging when diagnosing a skier's thumb should be reserved in cases when physical examination remains inconclusive.
Medical Center Haaglanden, Department of Surgery, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: mahajanmch@gmail.com.
Mandhkani
M
Mahajan
Medical Center Haaglanden, Department of Radiology, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: c.tolman@mchaaglanden.nl.
Christine
C
Tolman
Medical Center Haaglanden, Department of Emergency Care, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: b.wurth@mchaaglanden.nl.
B
B
Würth
Medical Center Haaglanden, Department of Surgery, Lijnbaan 32, 2512 VA The Hague, The Netherlands. Electronic address: s.rhemrev@mchaaglanden.nl.
Steven J
SJ
Rhemrev
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis*; D001696:Biomechanical Phenomena; D017885:Collateral Ligaments / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012421:Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012865:Skiing; D013933:Thumb / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery
MR; Skier's thumb; Sports injury; Ulnar collateral ligament