Metacarpophalangeal ulnar ligament rupture: Difference between revisions
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*Ulnar collateral ligament ruptures at insertion into proximal phalanx (due to radial deviation of MCP) | *Ulnar collateral ligament ruptures at insertion into proximal phalanx (due to radial deviation of MCP) | ||
*If left untreated, it will causes decreased thumb adduction and inability to perform opposition. | *If left untreated, it will causes decreased thumb adduction and inability to perform opposition. | ||
*The mechanism of injury is usually a rapid deceleration while holding onto an | *The mechanism of injury is usually a rapid deceleration while holding onto an object (such as a ski pole) | ||
==Clinical Features== | ==Clinical Features== | ||
*Swelling and localized tenderness over ulnar border of joint | *Swelling and localized tenderness over ulnar border of the thumb MCP joint | ||
*Weakness of pinch | *Weakness of pinch | ||
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===Stener Lesion=== | ===Stener Lesion=== | ||
This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Clinically characterized by extensive laxity on stress testing of the thumb MCP. Patients will require surgical repair<ref>Bowers WH, Hurst LC. Gamekeeper's thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59(4):519-524</ref> | *This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Clinically characterized by extensive laxity on stress testing of the thumb MCP. Patients will require surgical repair<ref>Bowers WH, Hurst LC. Gamekeeper's thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59(4):519-524</ref> | ||
==Management== | ==Management== | ||
All patients with suspected UCL injury should be referred | *All patients with suspected UCL injury should be referred to a hand surgeon within 1 week. Reevaluation will dictate operative management. | ||
*Partial rupture | *Partial rupture → Immobilization in [[thumb spica]] for 4 weeks with thumb in neutral position | ||
*Full rupture or Stener lesion → Operative repair | |||
*Full rupture or Stener lesion | |||
==Disposition== | ==Disposition== | ||
* | *Discharge with hand surgery follow up | ||
==See Also== | ==See Also== | ||
| Line 37: | Line 35: | ||
==External Links== | ==External Links== | ||
==Video== | ==Video== | ||
Latest revision as of 23:40, 23 February 2021
Background
- Also known as "Gamekeeper's thumb" or "Skier's thumb"
- Ulnar collateral ligament ruptures at insertion into proximal phalanx (due to radial deviation of MCP)
- If left untreated, it will causes decreased thumb adduction and inability to perform opposition.
- The mechanism of injury is usually a rapid deceleration while holding onto an object (such as a ski pole)
Clinical Features
- Swelling and localized tenderness over ulnar border of the thumb MCP joint
- Weakness of pinch
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- X-ray (perform before joint stressing)
- There is a high association with avulsion fractures from insertion of UCL into proximal phalanx
- Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
- Apply radial stress to the thumb with MCP in partial flexion
- Compare relative laxity to other thumb.
- >35 degrees of joint laxity or 15 degrees of releative laxity compared to other thumb is diagnostic of a complete UCL rupture[1]
Stener Lesion
- This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Clinically characterized by extensive laxity on stress testing of the thumb MCP. Patients will require surgical repair[2]
Management
- All patients with suspected UCL injury should be referred to a hand surgeon within 1 week. Reevaluation will dictate operative management.
- Partial rupture → Immobilization in thumb spica for 4 weeks with thumb in neutral position
- Full rupture or Stener lesion → Operative repair
Disposition
- Discharge with hand surgery follow up
See Also
External Links
Video
{{#widget:YouTube|id=0ZUtTT9v3r0}}