Gamekeeper thumb

Case contributed by Dr Fatmah M. Al Zeyoudi

Presentation

Patient presented to ER with left thumb pain secondary to trauma

Patient Data

Age: 35 years
Gender: Male
X-ray

There is intra-articular avulsion fracture of the base of the proximal phalanx of the left thumb

Case Discussion

Background.

The ulnar collateral ligament of the thumb MCP joint is the most frequently injured collateral ligament in the hand. The mechanism of injury is caused by valgus stress across the thumb, often combined with hyperextenion.

Management.

Most UCL sprains, partial tear and minimally displaced complete tear (as in our case) or avulsions, are managed by immobilization. Complete tear often required surgical exploration to locate and reattach the free edges of the torn ulnar collateral ligament.

Complication.

The adductor tendon aponeurosis of the thumb can become interposed between the torn edges of the ulnar collateral ligament, a condition termed the Stener lesion. MRI can aid to identified the position of the ligament. The displaced ligament will not heal appropriately, Stener lesions are surgically corrected with anatomic reattachment of the displaced ligament.

Special thanks to Dr. Tamer El Holiby

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Case information

rID: 50799
Case created: 22nd Jan 2017
Last edited: 3rd Jul 2017
Inclusion in quiz mode: Included

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