Difference between revisions of "Metacarpophalangeal ulnar ligament rupture"

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==Background==
 
==Background==
*Also known as gamekeeper's thumb or skier's thumb
+
*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 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==
 
==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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{{Hand and finger injury DDX}}
 
{{Hand and finger injury DDX}}
  
==Diagnosis==
+
==Evaluation==
 
*X-ray (perform before joint stressing)
 
*X-ray (perform before joint stressing)
**Bony avulsion from insertion of UCL into proximal phalanx
+
**There is a high association with avulsion fractures from insertion of UCL into proximal phalanx
**Associated condylar fracture
 
 
**Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
 
**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<ref>Ritting A et al. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20110;20(2):106-112</ref>
  
===Partial versus complete rupture===
+
===Stener Lesion===
*Valgus stress testing with joint in full extension and in 30 deg of flexion
+
*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>
**>35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture
 
  
 
==Management==
 
==Management==
*Partial rupture
+
*All patients with suspected UCL injury should be referred to a hand surgeon within 1 week.  Reevaluation will dictate operative management.
**Immobilize in [[thumb spica]] for 4wk
+
*Partial rupture → Immobilization in [[thumb spica]] for 4 weeks with thumb in neutral position
*Full rupture
+
*Full rupture or Stener lesion → Operative repair
**Referral within 1wk
 
  
 
==Disposition==
 
==Disposition==
*Outpatient treatment
+
*Discharge
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
 +
  
 
==Video==
 
==Video==
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<references/>
 
<references/>
  
[[Category:Ortho]]
+
[[Category:Orthopedics]]

Latest revision as of 05:38, 4 July 2017

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

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

See Also

External Links

Video

References

  1. Ritting A et al. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20110;20(2):106-112
  2. Bowers WH, Hurst LC. Gamekeeper's thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59(4):519-524