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MR Imaging of the Metacarpophalangeal Joints of the Fingers

Part I. Conventional MR Imaging and MR Arthrographic Findings in Cadavers¹

¹ From the Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161 (N.H.T., C.W.A.P., D.J.T., D.R.); Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (N.H.T.); and Department of Radiology B, CHU Cochin, Assistance Publique-Hôpitaux de Paris-Université Paris V, France (J.L.D.). Received December 18, 2000; revision requested February 7, 2001; final revision received July 25; accepted July 30. Supported by the Swiss Radiological Society and the Swiss National Science Foundation. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu). © RSNA, 2001

View larger version (62K): [in a new window]   Figure 1. Drawing illustrates transverse view of the main structures of the MCP joint after removal of the metacarpal head.

View larger version (70K): [in a new window]   Figure 2. Drawing of the extensor hood. The sagittal bands are located above the joint line, and the transverse fibers of the lumbrical and interosseous tendons are more distal, over the proximal phalanx.

View larger version (164K): [in a new window]   Figure 3a. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-echo MR arthrogram (500/12) and (b) corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.

View larger version (189K): [in a new window]   Figure 3b. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-echo MR arthrogram (500/12) and (b) corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.

View larger version (147K): [in a new window]   Figure 3c. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-echo MR arthrogram (500/12) and (b) corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.

View larger version (53K): [in a new window]   Figure 4. Drawing of the collateral ligament complex. The main collateral ligament is relaxed in extension and taut in flexion, and the accessory collateral ligament is taut in extension and more relaxed in flexion.

View larger version (135K): [in a new window]   Figure 5a. Transverse views of the MCP joint of the third finger in flexion, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (black arrowheads), distal attachments (white arrowheads), and taut body (arrow) of the main collateral ligament.

View larger version (141K): [in a new window]   Figure 5b. Transverse views of the MCP joint of the third finger in flexion, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (black arrowheads), distal attachments (white arrowheads), and taut body (arrow) of the main collateral ligament.

View larger version (143K): [in a new window]   Figure 5c. Transverse views of the MCP joint of the third finger in flexion, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (black arrowheads), distal attachments (white arrowheads), and taut body (arrow) of the main collateral ligament.

View larger version (137K): [in a new window]   Figure 6a. Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic specimen show the proximal (black arrowheads in a and b) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The interosseous tendons (white arrowheads) are well demonstrated. Note the intermetacarpophalangeal spaces (curved arrows in c) between the main collateral ligaments and the interosseous tendons.

View larger version (144K): [in a new window]   Figure 6b. Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic specimen show the proximal (black arrowheads in a and b) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The interosseous tendons (white arrowheads) are well demonstrated. Note the intermetacarpophalangeal spaces (curved arrows in c) between the main collateral ligaments and the interosseous tendons.

View larger version (142K): [in a new window]   Figure 6c. Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic specimen show the proximal (black arrowheads in a and b) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The interosseous tendons (white arrowheads) are well demonstrated. Note the intermetacarpophalangeal spaces (curved arrows in c) between the main collateral ligaments and the interosseous tendons.

View larger version (126K): [in a new window]   Figure 7a. Transverse views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (open arrow), distal attachments (long straight black arrow), and taut body (long straight white arrow) of the accessory collateral ligament. In b, the accessory collateral ligaments are better depicted with intraarticular contrast agent enhancement. The sagittal bands (white arrowheads), interosseous muscles (short black arrow in c) and tendons (short white arrows), PP (curved black arrow), A1 pulleys (black arrowheads), and DTML (curved white arrow in a and c) also are well demonstrated.

View larger version (134K): [in a new window]   Figure 7b. Transverse views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (open arrow), distal attachments (long straight black arrow), and taut body (long straight white arrow) of the accessory collateral ligament. In b, the accessory collateral ligaments are better depicted with intraarticular contrast agent enhancement. The sagittal bands (white arrowheads), interosseous muscles (short black arrow in c) and tendons (short white arrows), PP (curved black arrow), A1 pulleys (black arrowheads), and DTML (curved white arrow in a and c) also are well demonstrated.

View larger version (120K): [in a new window]   Figure 7c. Transverse views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo (a) conventional MR image (500/12) and (b) MR arthrogram (500/12) and (c) the corresponding anatomic section show the proximal attachments (open arrow), distal attachments (long straight black arrow), and taut body (long straight white arrow) of the accessory collateral ligament. In b, the accessory collateral ligaments are better depicted with intraarticular contrast agent enhancement. The sagittal bands (white arrowheads), interosseous muscles (short black arrow in c) and tendons (short white arrows), PP (curved black arrow), A1 pulleys (black arrowheads), and DTML (curved white arrow in a and c) also are well demonstrated.

View larger version (148K): [in a new window]   Figure 8. Transverse T1-weighted spin-echo MR arthrogram (500/12) of the MCP joint of the second and third MCP finger joints shows the fibrous connection (curved arrow) between the proprius and the common extensor tendon, the sagittal bands (arrowheads), the A1 pulley (thin straight arrows), the DTML (open arrows), and the lumbrical muscle (thick straight arrow). The line on the right side of image represents a 1-cm scale.

View larger version (108K): [in a new window]   Figure 9. Transverse T1-weighted spin-echo MR arthrogram (500/12) 1 cm distal to the MCP joints of the fourth and fifth fingers shows the transverse fibers (curved arrows) arising from the interosseous tendons (straight black arrows) and extending to the extensor tendon (white arrow). The line on the right side of image represents a 1-cm scale.