Metacarpophalangeal ulnar ligament rupture: Difference between revisions
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==Background== | ==Background== | ||
*Also known as | *Also known as "Gamekeeper's thumb" or "Skier's thumb" | ||
*Ulnar ligament ruptures at insertion into proximal phalanx (due to radial deviation of MCP) | *Ulnar 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 objection (such as a ski pole) | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 14:34, 24 November 2015
Background
- Also known as "Gamekeeper's thumb" or "Skier's thumb"
- Ulnar 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 objection (such as a ski pole)
Clinical Features
- Swelling and localized tenderness over ulnar border of 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
Diagnosis
- X-ray (perform before joint stressing)
- Bony avulsion from insertion of UCL into proximal phalanx
- Associated condylar fracture
- Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
Partial versus complete rupture
- Valgus stress testing with joint in full extension and in 30 deg of flexion
- >35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture
Management
- Partial rupture
- Immobilize in thumb spica for 4wk
- Full rupture
- Referral within 1wk
Disposition
- Outpatient treatment
See Also
External Links
Video
{{#widget:YouTube|id=0ZUtTT9v3r0}}