Skier's thumb
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Definition/Description[edit | edit source]
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Clinically Relevant Anatomy[edit | edit source]
Injury to the ulnar collateral ligament (UCL) at the metacarpophalangeal joint (MCPJ) of the thumb, also known as "skier's thumb," can involve other structures such as the adductor aponeurosis, the accessory collateral ligament, bony structures, tendons, and neurological tissues.[1]
There are two main supporting ligaments traversing the MCPJ of the thumb: the UCL and the radial collateral ligament (RCL). In general, UCL injuries account for 60-90% of ligamentous collateral injuries.[2] The UCL and RCL arise from the medial and lateral tubercles of the metacarpal condyles, respectfully, and insert into the base of the proximal phalanx on their respective sides (Figure 1).[2][3]
Figure 1. UCL and RCL of the thumb
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation
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The most common presentation is pain over the ulnar aspect of the MCPJ of the thumb. If the injury is acute there will be bruising and inflammation. There may be tenderness with palpation, which localizes the injury to the ulnar aspect of the thumb where the UCL is lesioned. Patients typically complain of pain and weakness when using a pincer grip. Examples include holding a pen, grasping objects, unscrewing jar lids and turning a key or doorknob.[4] In the instance of a Stener lesion, there may also be a palpable mass proximal to the adductor aponeurosis.[5]
Differential Diagnosis[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Nonoperative treatment is reserved for ligament strains, partial tears, low-demand patients and poor-operative candidates, including patients with degenerative MCP joint disease.[6] More specifically, conservative management is appropriate for patients with less than 30 degrees of valgus laxity of extension of the MCPJ, less than 15 degrees difference between sides, and no signs of avulsion fracture on radiographs.[7] Conservative treatment typically starts with some sort of immobilization process. A thumb spica cast, including the wrist, may also be worn until the initial inflammation is resolved, typically within a week.[8] Swelling can be controlled with elevation while supine, and the use of cold compresses as needed.[9]
Once the inflammation has resolved, the patient is advised to start wearing a thermoplastic splint. The thermoplastic splint allows for the patient to begin movement of the interphalangeal joint. Thermoplastic splinting can be used initially for less severe incomplete ligamentous injuries. Wearing a splint will avoid putting radial stress on the thumb and gives the ligament time to heal.[10] The optimal positioning for the splint involves holding the MCPJ in slight flexion with a slight ulnar deviation; the interphalangeal joints should not be immobilized in the splint. The patient should begin supervised hand therapy during the period of immobilization. The splint should be worn at all times, except for therapy sessions, for at least 6 weeks, after which the splint should only be worn during high risk situations, such as manual labor.[11]
Gentle flexion and extension range of motion exercises can begin after about four weeks, with the patient continuing to wear the splint between therapy sessions. After 8 weeks progressive strengthening exercises may begin, but unrestricted activity is not allowed until after 12 weeks.[12] Gripping and pinching activities should not started until 10-12 weeks and should be advanced as tolerated; forceful gripping activities are typically not tolerated until about week 12.[13]
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References[edit | edit source]
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- ↑ Anderson D. Skier's thumb. Aust Fam Physician. 2010;39(8):575-577.
- ↑ 2.0 2.1 Patel S, Potty A, Taylor EJ, Screne ED. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strat Trauma Limb Recon. 2010;5:1-10.
- ↑ Thumb sprains. American Society for Surgery of the Hand Web site. Available at: http://www.assh.org/Public/HandConditions/Pages/ThumbSprains.aspx. Accessed March 18, 2011.
- ↑ Patel S, Potty A, Taylor EJ, Screne ED. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strat Trauma Limb Recon. 2010;5:1-10
- ↑ Anderson D. Skier's thumb. Aust Fam Physician. 2010;39(8):575-577.
- ↑ Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg. 2009;13(1):7-10.
- ↑ Anderson D
- ↑ Anderson D
- ↑ Seven
- ↑ Anderson D
- ↑ Anderson D
- ↑ Anderson D
- ↑ Rettig
