Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries
Objective: To assess the effectiveness of a systematic examination of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) prior to and post infiltration of local anaesthetic. Methods: During the study period from 24 October 2001 to 22 February 2002, 51 patients with c...
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| Veröffentlicht in: | Emergency medicine Australasia 2005-04, Vol.17 (2), p.132-136 |
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| creator | Cooper, Jamie G Johnstone, Alan J Hider, Phil Ardagh, Michael W |
| description | Objective: To assess the effectiveness of a systematic examination of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) prior to and post infiltration of local anaesthetic.
Methods: During the study period from 24 October 2001 to 22 February 2002, 51 patients with clinical signs suggestive of UCL injuries were identified prospectively from initial ED attendances and attendances at a subsequent review clinic. Patients were formally assessed a mean of 6.6 days post injury. A single ED Senior House Officer carried out examination before and after direct infiltration of local anaesthetic around the site of injury. Stress radiography was also performed as the ‘gold standard’ diagnostic test of UCL instability.
Results: Forty‐seven patients were enrolled in the study. When reviewed by the single observer, examination prior to and post local anaesthetic infiltration revealed a degree of joint stability in 28% (95% CI 16–43%) and 98% (95% CI 88–100%) cases, respectively, compared to the gold standard. Post infiltration, this technique had a specificity of 100% (95% CI 94–100%) and a sensitivity of 87.5% (95% CI 74–95%) (P |
| doi_str_mv | 10.1111/j.1742-6723.2005.00704.x |
| format | Article |
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Methods: During the study period from 24 October 2001 to 22 February 2002, 51 patients with clinical signs suggestive of UCL injuries were identified prospectively from initial ED attendances and attendances at a subsequent review clinic. Patients were formally assessed a mean of 6.6 days post injury. A single ED Senior House Officer carried out examination before and after direct infiltration of local anaesthetic around the site of injury. Stress radiography was also performed as the ‘gold standard’ diagnostic test of UCL instability.
Results: Forty‐seven patients were enrolled in the study. When reviewed by the single observer, examination prior to and post local anaesthetic infiltration revealed a degree of joint stability in 28% (95% CI 16–43%) and 98% (95% CI 88–100%) cases, respectively, compared to the gold standard. Post infiltration, this technique had a specificity of 100% (95% CI 94–100%) and a sensitivity of 87.5% (95% CI 74–95%) (P < 0.001). Stress radiography offered additional information in one patient. A total of eight patients previously underdiagnosed in the ED were found to have unstable thumb MCPJs.
Conclusion: This simple technique improves assessment of suspected UCL injuries approximately 1 week post injury. Further studies are indicated to determine its effectiveness in the ED immediately post injury.</description><identifier>ISSN: 1742-6731</identifier><identifier>EISSN: 1742-6723</identifier><identifier>DOI: 10.1111/j.1742-6723.2005.00704.x</identifier><identifier>PMID: 15796727</identifier><language>eng</language><publisher>Melbourne, Australia: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Aged ; Anesthetics, Local - administration & dosage ; Collateral Ligaments - injuries ; Emergency Medicine - methods ; Female ; Follow-Up Studies ; Hand Injuries - complications ; Hand Injuries - diagnosis ; Humans ; Injections ; injury ; Joint Instability - diagnosis ; Joint Instability - etiology ; local anaesthetic ; Male ; Metacarpophalangeal Joint ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Stener ; thumb ; Thumb - injuries ; ulnar collateral ligament</subject><ispartof>Emergency medicine Australasia, 2005-04, Vol.17 (2), p.132-136</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3194-eca4f70bb767c51baef239cffaf44089922749e95b0c6a922933d39efddb0e213</citedby><cites>FETCH-LOGICAL-c3194-eca4f70bb767c51baef239cffaf44089922749e95b0c6a922933d39efddb0e213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1742-6723.2005.00704.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1742-6723.2005.00704.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15796727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cooper, Jamie G</creatorcontrib><creatorcontrib>Johnstone, Alan J</creatorcontrib><creatorcontrib>Hider, Phil</creatorcontrib><creatorcontrib>Ardagh, Michael W</creatorcontrib><title>Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries</title><title>Emergency medicine Australasia</title><addtitle>Emerg Med Australas</addtitle><description>Objective: To assess the effectiveness of a systematic examination of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) prior to and post infiltration of local anaesthetic.
Methods: During the study period from 24 October 2001 to 22 February 2002, 51 patients with clinical signs suggestive of UCL injuries were identified prospectively from initial ED attendances and attendances at a subsequent review clinic. Patients were formally assessed a mean of 6.6 days post injury. A single ED Senior House Officer carried out examination before and after direct infiltration of local anaesthetic around the site of injury. Stress radiography was also performed as the ‘gold standard’ diagnostic test of UCL instability.
Results: Forty‐seven patients were enrolled in the study. When reviewed by the single observer, examination prior to and post local anaesthetic infiltration revealed a degree of joint stability in 28% (95% CI 16–43%) and 98% (95% CI 88–100%) cases, respectively, compared to the gold standard. Post infiltration, this technique had a specificity of 100% (95% CI 94–100%) and a sensitivity of 87.5% (95% CI 74–95%) (P < 0.001). Stress radiography offered additional information in one patient. A total of eight patients previously underdiagnosed in the ED were found to have unstable thumb MCPJs.
Conclusion: This simple technique improves assessment of suspected UCL injuries approximately 1 week post injury. Further studies are indicated to determine its effectiveness in the ED immediately post injury.</description><subject>Adolescent</subject><subject>Aged</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Collateral Ligaments - injuries</subject><subject>Emergency Medicine - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hand Injuries - complications</subject><subject>Hand Injuries - diagnosis</subject><subject>Humans</subject><subject>Injections</subject><subject>injury</subject><subject>Joint Instability - diagnosis</subject><subject>Joint Instability - etiology</subject><subject>local anaesthetic</subject><subject>Male</subject><subject>Metacarpophalangeal Joint</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Stener</subject><subject>thumb</subject><subject>Thumb - injuries</subject><subject>ulnar collateral ligament</subject><issn>1742-6731</issn><issn>1742-6723</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUMtOxCAUJUbj-xdMV-5aodAyJG6M8ZlRE6PRHbllLsrYaRXaOPP3UmcybmXDPZwHcAhJGM1YXCfTjEmRp6XMeZZTWmSUSiqy-QbZXROb65mzHbIXwpTSfCSY2iY7rJAqauQucePWQJ1AAxi6d-ycSVxjXd156FzbRGA8QsCQRDYBY3oPZpG0NoEQT8MMm25Afd2AT0xb19Chj4m1e4Nf0jXT3jsMB2TLQh3wcLXvk-fLi6fz63T8cHVzfjZODWdKpGhAWEmrSpbSFKwCtDlXxlqwQtCRUnkuhUJVVNSUEJHifMIV2smkopgzvk-Ol7mfvv3q46_0zAWD8WENtn3QpSxKKspRFI6WQuPbEDxa_endDPxCM6qHmvVUDw3qoU091Kx_a9bzaD1a3dFXM5z8GVe9RsHpUvDtalz8O1hf3N3FIdrTpd2FDudrO_iP6OGy0C_3V_qxoPeK01v9yn8A3k2c7A</recordid><startdate>200504</startdate><enddate>200504</enddate><creator>Cooper, Jamie G</creator><creator>Johnstone, Alan J</creator><creator>Hider, Phil</creator><creator>Ardagh, Michael W</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200504</creationdate><title>Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries</title><author>Cooper, Jamie G ; Johnstone, Alan J ; Hider, Phil ; Ardagh, Michael W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3194-eca4f70bb767c51baef239cffaf44089922749e95b0c6a922933d39efddb0e213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Aged</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Collateral Ligaments - injuries</topic><topic>Emergency Medicine - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hand Injuries - complications</topic><topic>Hand Injuries - diagnosis</topic><topic>Humans</topic><topic>Injections</topic><topic>injury</topic><topic>Joint Instability - diagnosis</topic><topic>Joint Instability - etiology</topic><topic>local anaesthetic</topic><topic>Male</topic><topic>Metacarpophalangeal Joint</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Stener</topic><topic>thumb</topic><topic>Thumb - injuries</topic><topic>ulnar collateral ligament</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cooper, Jamie G</creatorcontrib><creatorcontrib>Johnstone, Alan J</creatorcontrib><creatorcontrib>Hider, Phil</creatorcontrib><creatorcontrib>Ardagh, Michael W</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency medicine Australasia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cooper, Jamie G</au><au>Johnstone, Alan J</au><au>Hider, Phil</au><au>Ardagh, Michael W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries</atitle><jtitle>Emergency medicine Australasia</jtitle><addtitle>Emerg Med Australas</addtitle><date>2005-04</date><risdate>2005</risdate><volume>17</volume><issue>2</issue><spage>132</spage><epage>136</epage><pages>132-136</pages><issn>1742-6731</issn><eissn>1742-6723</eissn><abstract>Objective: To assess the effectiveness of a systematic examination of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) prior to and post infiltration of local anaesthetic.
Methods: During the study period from 24 October 2001 to 22 February 2002, 51 patients with clinical signs suggestive of UCL injuries were identified prospectively from initial ED attendances and attendances at a subsequent review clinic. Patients were formally assessed a mean of 6.6 days post injury. A single ED Senior House Officer carried out examination before and after direct infiltration of local anaesthetic around the site of injury. Stress radiography was also performed as the ‘gold standard’ diagnostic test of UCL instability.
Results: Forty‐seven patients were enrolled in the study. When reviewed by the single observer, examination prior to and post local anaesthetic infiltration revealed a degree of joint stability in 28% (95% CI 16–43%) and 98% (95% CI 88–100%) cases, respectively, compared to the gold standard. Post infiltration, this technique had a specificity of 100% (95% CI 94–100%) and a sensitivity of 87.5% (95% CI 74–95%) (P < 0.001). Stress radiography offered additional information in one patient. A total of eight patients previously underdiagnosed in the ED were found to have unstable thumb MCPJs.
Conclusion: This simple technique improves assessment of suspected UCL injuries approximately 1 week post injury. Further studies are indicated to determine its effectiveness in the ED immediately post injury.</abstract><cop>Melbourne, Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>15796727</pmid><doi>10.1111/j.1742-6723.2005.00704.x</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Adolescent Aged Anesthetics, Local - administration & dosage Collateral Ligaments - injuries Emergency Medicine - methods Female Follow-Up Studies Hand Injuries - complications Hand Injuries - diagnosis Humans Injections injury Joint Instability - diagnosis Joint Instability - etiology local anaesthetic Male Metacarpophalangeal Joint Middle Aged Predictive Value of Tests Prospective Studies Stener thumb Thumb - injuries ulnar collateral ligament |
| title | Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries |
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