?Thumb MCPJ Hemarthrosis

[Diane]

Hi Steve,

I scanned this teenager who hyperextended his thumb during footy. Very tender dorsal aspect of MCPJ. When I was flexing his thumb, it looked like the joint was slightly widened compared to the right side. Also thought there was echogenic fluid within the joint, would this be blood? I was thinking back to your lectures where blood often means fracture? Could you get blood in the joint without having a fracture?

I thought the collateral ligaments were NAD. Pt stated XR done a week prior elsewhere NAD.

Thanks!

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[Stephen Bird]

Hi Diane,

That looks exactly like a haemarthrosis.

The capsular ligaments also look a bit hypo echoic and thick.

You don’t need a fracture to get a haemarthrosis as any intra-articular injury can bleed into the joint.

I always consider a fracture when I see a haemarthrosis, but it is not always present.

The fact there is a haemarthrosis may indicate cross sectional imaging if the symptoms don’t resolve.

Steve.

[Diane]

Would there be any significance for the slightly widened joint compared to the asymptomatic left side or is this due to the extra blood in there?

Thanks!

[Stephen Bird]

think the capsule ligaments looked a bit thick and hypo echoic,

I think the capsule has been injured without a complete disruption.

The injured capsule will account for the joint laxity / hyper-mobility.

Steve.

[Diane]

Does this laxity get better with time or does it remain like that?

Thanks!

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