Gamekeeper's thumb (also known as thumb skiers or UCL torn ) is a type of injury to the ulnar collateral ligament (UCL) of the thumb. UCL can be torn, damaged or in some cases avulsion of the insertion site into the proximal phalanx of the thumb in most (about 90%) of the cases. This condition is often observed among Scottish avian gamekeepers and hunters, as well as athletes (such as volleyball players). This is also the case among people holding back from falling into outstretched hands, often skiers.
Video Ulnar collateral ligament injury of the thumb
Signs and symptoms
Symptoms of thumb gamekeeper is MCP thumb joint instability, accompanied by pain and weakness of pinch grip. The severity of the symptoms is related to the rate of initial UCL tear (in the case of Skier thumb), or how long the injury has been allowed to develop (in the case of a gamekeeper).
The characteristic signs include pain, swelling, and ecchymosis around the famous eminence, and especially above the MCP thumb joint. Physical examination shows the instability of the MCP joints from the thumb.
Patients will often show weak ability to hold objects or perform tasks such as tying shoes and tearing a piece of paper. Other complaints include severe pain experienced when capturing the thumb on an object, such as when reaching into a pants pocket.
Maps Ulnar collateral ligament injury of the thumb
Diagnosis
The thumb and gamekeeper thumb are two of the same conditions, both of which involve the insufficiency of the ulnar collateral ligament (UCL) of the thumb. The main difference between these two conditions is that Skier's thumb is generally regarded as an acute condition obtained after a fall or a similar abduction injury in the thoracarpophalangeal (MCP) joint of the thumb, whereas the thumb of the gamekeeper usually refers to a chronic condition that has developed. as a result of recurrent episodes of low-level hyperabduction over a period of time. Gamekeeper thumbs are harder to treat because UCL has been extended and becomes thinner due to repeated injuries. This is quite painful compared to similar injuries.
In addition to skiing, this injury (due to the forced abduction or hyperextension of the proximal phalanx of the thumb) is seen in a variety of other athletic sports. The most common injury mechanism is when a person stretches out his arm in an attempt to block a fall. The stress generated from falling to the kidnapped thumb generates the strength of valgus on the thumb MCP joint, resulting in a sprain or UCL tear.
In a recent study, 49% of UCL-induced thumb disorders were caused by falling into outstretched hands. Sports injuries accounted for most of the remaining injuries, with only 2.4% being acquired as a result of ski injuries.
Treatment
The ulnar collateral ligament is an important stabilizer of the thumb. Thumb instabilities resulting from UCL interference greatly disrupt the overall function of the hands involved. Therefore, it is very important that this injury receives proper attention and care.
In most cases of complete tear, adductor pollicis muscle aponeurosis can be inserted between the joints of the torn joints of MCP and ligaments. When this condition (referred to as the Stener lesion) occurs, adequate healing of the tears is prevented altogether. For Stener lesions to occur, a complete tear of the ulnar ligament must exist. However, Stener lesions can occur even in the absence of tears from collateral ligaments of accessories or volar plates. Steneral lesions present in more than 80% of complete ruptures of UCL thumb.
When approaching this type of injury, the physician must first determine whether there is an imperfect (or sprained) rupture of UCL, or a complete rupture. If UCL is really disturbed, the doctor should then determine whether there is an interposition of adductor aponeurosis (Stener lesion), or only complete rupture of UCL with anatomical or near anatomical position. Radiography is helpful in determining the possibility of an avulsion fracture from the proximal phalanx insertion site of the ulnar collateral ligament. A stress check, or performed under fluoroscopic guidance, may help determine ligament integrity.
Most partial thumb injuries of the gamekeeper are treated by simply paralyzing the joints in spint thumb spica or modified wrist splints and allowing the ligaments to heal. However, near total or total tear from UCL may require surgery to achieve satisfactory improvement, especially if accompanied by Stener lesions.
History
CS Campbell, an orthopedic surgeon, originally coined the term gamekeeper in 1955, after he observed this condition in a series of 24 Scottish magical players. Injuries seem to occur as a result of certain ways in which they kill small animals such as rabbits; the animals are placed on the ground, and their necks are broken as the animal watchdog puts downward pressure with the thumb and forefinger. This maneuver will place the strength of valgus on the abducted metacarpophalangeal (MCP) joint. Over time, this will lead to insufficiency of the ulnar collateral ligament (UCL) of the thumb.
Others have noted that Scottish birds or game hunters will develop this type of injury after taking their games back into the skin, which they will attach to their thumbs and hung over their shoulders.
The term thumb of a skier comes from the fact that skiers often get this type of injury by falling onto a planted ski pole, tearing up UCL by performing hyperabducting.
See also
- Bennett Fracture
- Rolando Fracture
References
External links
- Wheeless' Textbook of Orthopedics Online: Gamekeeper Thumb
Source of the article : Wikipedia
0 Comments