Imaging Guidelines for Thumb Trauma

Initial Assessment and Radiographic Protocol

The American College of Radiology recommends x-raying the thumb immediately when there is focal tenderness over bony structures, visible deformity, significant mechanism of injury, or clinical suspicion of fracture or dislocation following trauma 1
X-rays are indicated for acute thumb trauma if there is focal bony tenderness, visible deformity, significant mechanism of injury, or penetrating injury to the thumb 1, 2
A minimum 3-view examination, including posteroanterior, true lateral, and oblique views, is recommended when x-rays are indicated 3

MRI without IV contrast is the preferred advanced imaging when initial x-rays are negative but clinical suspicion remains high, or when tendon or ligamentous injury assessment is needed 1, 3
MRI has 100% sensitivity and 94-100% specificity for detecting Stener lesions and complete ulnar collateral ligament tears 1
CT is rarely indicated for acute thumb metacarpal or phalangeal fractures, but may be useful for complex intra-articular fractures requiring surgical planning 3, 4