An international survey of 262 hand surgeons on the diagnosis and treatment of thumb ulnar collateral ligament injuries

Abstract

Purpose Despite the frequent occurrence of thumb ulnar collateral ligament injury, evidence supporting current diagnostic and treatment recommendations remains limited. To identify areas where comparative research is needed to support future evidence-based guidelines and potential challenges to their subsequent implementation, this study aimed to characterize international practice patterns, identifying consensus and variation. Methods A web-based international survey was distributed between May and December 2024 through professional societies for hand surgery and associated clinical networks. The questionnaire comprised twenty-five items covering clinician characteristics, diagnostic strategies, and treatment preferences. Responses were analyzed descriptively and stratified by geographic region and years of clinical experience. Results Of 293 returned questionnaires, 262 were eligible for analysis. Respondents had practiced for a median of thirteen years, and most were based in Europe. Physical examination was considered sufficient to diagnose a complete ligament tear by most respondents (78%), whereas far fewer regarded it sufficient to detect a Stener lesion (27%). Radiographs were routinely used by 69%, ultrasound by 51%, and MRI by 40%. There was consensus for operative treatment of Stener lesions (95%) and displaced avulsion fractures (79%). Considerable variation existed for complete tears without Stener lesion: 59% preferred surgery, 52% would also attempt nonoperative treatment, and 25% reported they would never consider conservative management for any full-thickness tear. Conclusion These findings identify areas of variation in which comparative evidence may be most relevant, while also showing where existing practice patterns may influence future guideline implementation.