Thank you to Dr. Aherne for this edition of Morning Report,
Gamekeeper’s Thumb/Skier’s Thumb
- Injury to the Ulnar Collateral Ligament (UCL) of the thumb
- True gamekeeper’s thumb is a chronic condition, due to repeated valgus force on MCP joint while killing or carrying game, leading to insufficiency of the UCL over time
- Skier’s Thumb is an acute injury due to acute hyperabduction of the thumb, typically during a fall on outstretched hand with abducted thumb.
- Symptoms: Instability of MCP joint, and pain and weakness with pincer grasp (tying shoes, tearing paper), extreme pain when catching thumb on objects
- Signs: swelling, tenderness, ecchymosis around thenar eminence
- Stener Lesion: In 80% of complete tears of the UCL, aponeurosis of the adductor pollicis is interposed between MCP joint and the torn ligament, preventing opportunity for healing
- Exam:
- Pain control/local anesthetic
- Check for stability; start with the unaffected thumb to evaluate baseline ROM and valgus stability in both extension and 30° flexion
- Check affected thumb for laxity at the MCP joint with valgus stress: radial deviation of >40° in extension, and >20° in flexion
- Management:
- Xrays: evaluate for avulsion fx of proximal phalanx at insertion site
- 3mm of volar subluxation of the phalanx on the metacarpal is suggestive of complete UCL rupture
- Stress radiographs to determine extent of instability
- Splint: Thumb spica to immobilize
- Complete Tear/Stener Lesion: Surgery: Ideally within first week; after three weeks, increased incidence of weakness
- 50% failure rate of complete tears treated with bracing and early motion
- Partial tear: 4 weeks immobilization
Thanks for reading,
JK
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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