skier’s thumb
TRANSCRIPT
Dr. Santosh Batajoo Resident (Orthopaedic Surgery)
Skier’s Thumb
Injury to the metacarpophalangeal joint ulnar collateral ligament of the thumb.
A tear or avulsion of the ligament may occur at the site of insertion into the phalanx of the thumb.
Skier’s thumb- acute condition
Gamekeeper’s thumb – chronic condition – as a result of repeated episodes.
introduction
C S Campbell, an orthopedic surgeon originally coined the term gamekeeper’s thumb in 1955, after he observed this condition in a series of Scottish gamekeepers.
history
Gamekeeper’s – who kill small animals by forcefully extending the neck.
Skiers- who fall onto the extended thumb, hyperabduction.
athletes
The capsule is thickened medially and laterally to form the ulnar and radial collateral ligaments which are static stabilizer of MCP joint.
Ligament- proper and accessory ulnar collateral ligament
The capsule is thin over its dorsolateral aspect between EPB and abductor pollicis. dorsomedial aspect between the EPB and the adductor
pollicis.
anatomy
Rupture of ulnar collateral ligament caused by forcible abduction.
Fall onto an outstretched hand.
Gamekeeper’s fracture – an avulsion fracture
mechanism
A. Partial rupture – only the ligament proper is torn. Thumb is unstable in flexion.
B. Complete rupture – Thumb is unstable in all the positions.
types
The stener lesion – Interposition of the adductor pollicis aponeurosis between the ends of the torn ligament.
Prevent healing of the ligament.
Chronic instability.
Present in about 80% of complete ruptures.
type injury treatment
1
2
3
4
5
6
Fracture undisplaced
Fracture displaced
Ligamentous tear, stable
Ligamentous tear, unstable
Volar lip fracture
Ulnovolar fracture and ligamentous tear.
Conservative
Surgical
Conservative
Surgical
Conservative
surgical
Classification (palmer & louis)
Swelling and tenderness over the ulnar side of the thumb metacarpophalangeal joint.
Bruise like discoloration around the joint.
Interference in pinching activity, grasp.
Laxity of the joint
Lump (stener lesion).
Clinical features
Abduction stress testing Joint in full extension and 30 degrees of flexion.
Should be compared with the uninjured thumb.
Stress test in extension with abduction more than 40 degree indicates a complete injury. Compared to other side- difference of more than 15 degree.
X-ray – To exclude a fracture. avulsion fracture: fragment from the base of the proximal phalanx. Subluxation Stress view examination Minimally displaced (<2mm) avulsion fracture – complete avulsion without Stener lesion.
Ultrasonography MRI
investigations
Chronic instability
Arthritic changes in the MCP joint.
Weak pinch grasp.
Stiffness of the MCP and IP joints.
Neurapraxia of the radial sensory nerve.
complications
Partial tear- Immobilization in a splint for 4-6 weeks followed by
movement. Thumb spica cast or brace.
Complete tear- Operative repair. Immobilized postoperatively for 6
weeks. Flexion extension can be started early. Interphalangeal joint should be left free. Unrestricted usage is allowed at 3 months.
treatment
Delayed diagnosis – dissecting out the ligament from within the fibrotic mass and reattaching it.
Late diagnosed complete tear (several months) - Repair of the capsulo-ligamentous complex with a
palmaris longus free tendon graft or MP joint fusion.
If arthritis is present, arthrodesis of the MCP joint.
Early diagnosis is the important determinant of functional outcome.
Complete ruptures that are surgically treated within 3 weeks have good result.
The prognosis for repairs undertaken longer than 6 weeks is poor.
Physical therapy after surgery.
Outcome and prognosis
Thank you…