Pitfalls

• Careful dissection over the SRN will avoid permanent numbness to the inside of the thumb.

• Inadequate conservative treatment and lack of identification of the Stener lesion can lead to instability and require fusion of the MP joint.

• Patients can have stiffness after this injury.

may be necessary for accurate stress radiographs if pain is intolerable. An injured thumb that demonstrates more than 30 degrees of instability compared with the contralateral and uninjured side indicates a complete UCL rupture.

To differentiate between nondisplaced UCL injuries and the presence of a Stener lesion, magnetic resonance imaging (MRI) is helpful because it is both sensitive and specific for this soft tissue injury (UCL). The use of MRI facilitates a more accurate diagnosis and allows the physician to recommend the most optimal course of treatment for each case. The MRI is effective in distinguishing displaced versus non-displaced acute UCL lesions with or without the presence of a Stener lesion. This information is crucial in determining treatment. If a patient has a grade III UCL tear, yet no Stener, one might argue that nonoperative treatment is sufficient with casting. The MRI takes only 20 minutes and is cost efficient (Fig. 51-4).

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

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