I received only one comment about this case, from Connie Chang, who is one of my main go-to consultants on finger imaging….
i think you’re right about all of it – junction central/lateral slip tear, rcl midsubstance tear, also accessory band tear near its origin. I think the rcl is balled up – the proximal end of the distal piece appears to be flipped distally (long white arrow, second to last image/coronal image).
She agrees that the extensor hood is superficial to the torn RCL…and added:
according to jon jacobson – "stener-like" is just whether you think it’ll spontaneously heal or not. so, if it’s balled up, even if it’s deep to the hood, it probably won’t heal spontaneously. but we spoke to the surgeon about the mcp joints and they said that the instability is usually tolerable so even though it doesn’t heal they don’t really do anything about it. might be true for the pip joints too.
There is a full thickness tear at the junction of the lateral and central slip of the EDC tendon
The same tear in the Axial plane
The long white arrow points to what seems like a midsubstance PIP RCL rupture…which seems odd…I thought it usually tears at an insertion
The short arrow points to soft tissue thickening along the course of the RCL, but the UCL inserts more distally onto the prox phalanx
Is it just thickened and a bit delaminated proximally, or am I seeing injuries to both the Proper and Accessory Radial Collateral ligament?
I’m certain this makes no difference to the surgical repair, I just want to understand this
Also, is that the extensor hood elevated superficial to the RCL and UCL?
Thank you
Hilary
