Background: Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.
Methods: Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.
Results: The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.
Conclusions: Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.
肌腱或韧带断裂引起的运动损伤手指拇指畸形摘要背景：手指肌腱韧带损伤在临床上很常见，该研究利用3.0 T高分辨MRI研究手指肌腱韧带的正常解剖及运动损伤的影像学特点，为手指肌腱韧带运动损伤导致的手指畸形，提供精准的MR诊断依据。 方法：选择8具尸体中的16只新鲜尸体手标本，进行磁共振检查和相应层面的断层解剖切片，研究尸体标本的正常解剖结构和MR表现，选择20位健康志愿者，研究健康志愿者的正常MR表现特点。选择44例手指肌腱韧带运动损伤导致手指畸形的患者，进行病变部位的MR检查。所有标本和受试者均接受MRI扫描，扫描序列包括T1WI和PD-FS（质子抑脂）序列，扫描体位包括横轴位、冠状位及矢状位。将MR检查后的手指标本采用断层解剖带锯切割，16只尸体手标本（6只手标本以冠状面切割，6只以矢状面，4只以轴位切割）层厚为2mm，分析断层解剖标本与相应层面MRI影像特点的相关性。20例健康志愿者与44例经手术证实具有运动损伤畸形的患者均行MR检查，研究手指肌腱韧带和拇指掌指关节的尺侧副韧带损伤畸形的MRI影像特点。 结果：16只尸体手标本及20位健康志愿者手指的正常韧带和肌腱在MRI各个序列上均表现为均匀低信号。44例有手指肌腱或韧带损伤的患者中，拇指掌指关节尺侧副韧带损伤12例（Stener损伤8例，非Stener损伤4例），中央束损伤6例，末端腱损伤12例，指深屈肌腱损伤14例。韧带和肌腱损伤断裂表现为病变部位信号增高，被液体充填，肌纤维结构显示不清，相应韧带肌腱纤维不连续，信号不均匀。 结论：手指运动损伤导致的畸形临床上比较常见。高分辨MRI能够准确评价手指的正常解剖结构，以及损伤部位的MR特点，为损伤的早期诊断治疗及术后随访康复提供科学准确的影像学依据。.
Keywords: Boutonniere Deformity; Fingers; Jersey Finger; Magnetic Resonance Imaging; Mallet Finger; Stener Lesion; Thumb.