The accuracy of MRI diagnosis of thumb ulnar collateral ligament injuries over physical examination in clinical decision-making for surgery

Purpose

This retrospective study assessed whether magnetic resonance imaging (MRI) confers a diagnostic or therapeutic advantage over clinical examination in managing thumb ulnar collateral ligament (UCL) injuries and evaluated its accuracy in lesion characterization.

Materials and methods

We reviewed 96 patients undergoing surgical repair over a ten-year period, 43 of whom had preoperative MRI and 53 who did not.

Results

While MRI exhibited high sensitivity (97%) and specificity (80%) for detecting UCL pathology, its accuracy for differentiating lesion subtypes was only moderate (72–84%). No appreciable difference was noted between MRI and non-MRI cohorts in the proportion of indication-appropriate (57% vs. 45%) or surgeries potentially amenable to conservative treatment (43% vs. 55%).

Conclusions

Thus, MRI did not influence the indication for surgery beyond what was determined by a meticulous physical examination. A thorough clinical assessment remains the mainstay, reserving MRI for diagnostically challenging scenarios or when detailed anatomical visualization is necessary.