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European Radiology
Published in: European Radiology 8/2021

01-08-2021 | Magnetic Resonance Imaging | Musculoskeletal

Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis

Authors: Ali Rashidi, Arya Haj-Mirzaian, Danoob Dalili, Benjamin Fritz, Jan Fritz

Published in: European Radiology | Issue 8/2021

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Abstract

Objectives

To determine the performances of clinical examination, ultrasonography, and MRI for diagnosing non-displaced and displaced ulnar collateral ligament (UCL) tears.

Methods

Based on a literature search of Medline, ISI Web of Science, Embase, and Scopus between January 1990 and December 2019, all published original articles which met the inclusion criteria were included. We determined the pooled sensitivities, specificities, and accuracies of clinical examination, ultrasonography, and MRI using a meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Diagnostic Test Accuracy (PRISMA-DTA) guidelines.

Results

A total of 17 studies with 519 subjects reporting diagnostic performances of clinical examination (8), ultrasonography (12), and MRI (5) met the inclusion criteria. For ruling out UCL tears, the pooled sensitivities were similarly high for clinical examination (97% (95% confidence interval [CI], 93–99%)), ultrasonography (96% (95% CI, 94–98%)), and MRI (99% (95% CI, 92–100%)) (p = 0.3). For ruling in UCL tears, the pooled specificities were higher for MRI (100% (95% CI, 87–100%)) when compared to ultrasonography (91% (95% CI, 86–95%)) (p = 0.1) and clinical examination (85% (95% CI, 78–91%)) (p = 0.04). For the diagnosis of displaced UCL tears, MRI had a higher specificity (92% (95% CI, 73–99%)) than ultrasonography (72% (95% CI, 63–80%)) (p = 0.2).

Conclusions

Clinical examination, ultrasonography, and MRI have similarly high sensitivities for ruling out UCL tears in patients presenting with a thumb injury. MRI and ultrasonography have high specificities to confirm the presence of suspected UCL tears. MRI performs best for differentiating non-displaced from displaced UCL tears.

Key Points

• Clinical examination followed by ultrasonography is the most appropriate test for ruling out ulnar collateral ligament (UCL) tears of the thumb.
• MRI and ultrasonography both have high specificities to confirm the presence of a suspected UCL tear.
• MRI outperforms ultrasonography for differentiating non-displaced from displaced UCL tears.
Appendix
Available only for authorised users
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Metadata
Title
Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis
Authors
Ali Rashidi
Arya Haj-Mirzaian
Danoob Dalili
Benjamin Fritz
Jan Fritz
Publication date
01-08-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07666-z

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