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Thumb Collateral Ligament Injury

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Topic updated on 10/04/13 7:01pm
Introduction
  • Thumb collateral ligament injuries include
    • radial collateral ligament
      • rare
    • ulnar collateral ligament
      • most common
      • eponyms for ulnar collateral ligament  (UCL) injury are
        • Gamekeeper's thumb for chronic injury
        • skiers thumb for acute injury
        • Stener lesion 
          • avulsed ligament with or without bony attachement is displaced above the adductor aponeurosis
          • will not heal without surgical repair
  • Epidemiology
    • UCL more common than radial collateral ligament
  • Mechanism
    • hyper abduction or extension at the MCP joint
Anatomy
  • UCL is composed of 
    • proper collateral ligament 
      • resists valgus load with thumb in flexion
    • accessory collateral ligament and volar plate 
      • resists valgus load with thumb in extension
      • valgus laxity in both flexion and extension is indicative of a complete UCL rupture 
Presentation
  • History
    • hyperabduction injury
  • Symptoms
    • pain at ulnar aspect of thumb MCP joint
  • Physical exam
    • inspection and palpation
      • mass from torn ligament and possible bony avulsion may be present
    • stress joint with radial deviation both at neutral and 30° of flexion
      • instability in 30° of flexion indicates injury to proper UCL
      • instability in neutral indicates injury to accessory UCL and/or volar plate
      • compare to uninjured thumb MCP joint

Imaging
  • Radiographs  
    • recommended views
      • AP, lateral and oblique of thumb
      • valgus stress view may aid in diagnosis if a bony avulsion has already been ruled out
  • MRI
    • can aid in diagnosis if exam equivocal

Treatment
  • Nonoperative
    • immobilization for 4 to 6 weeks
      • indications
        • partial tears with < 20° side to side variation of varus/valgus instability
  • Operative
    • ligament repair
      • indications
        • acute injuries with
          • > 20° side to side variation of varus/valgus instability
          • >35° of opening
        • Stener lesion  
          • avulsed ligament with or without bony attachement is displaced above the adductor aponeurosis
          • will not heal without surgical repair
      • technique
        • can use suture, suture anchors, or small screw to repair ligament
    • reconstruction of ligament with tendon graft, MCP fusion, or adductor advancement
      • indications
        • chronic injury
Radial Collateral Ligament Injury
  • Rare
  • Treatment
    • nonoperative
      • immobilization
        • indicated in most cases
        • Stener's lesion does not occur

 

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Qbank (1 Questions)

TAG
(OBQ10.213) Creation of a Stener lesion, as found in Gamekeeper's thumb, requires combined tears of the proper and accessory ulnar collateral ligaments in order for the ligament to be displaced by the adductor aponeurosis. Which of the following most accurately describes the role these ulnar collateral ligaments (PCL/ACL) play in thumb MCP joint stability? Topic Review Topic

1. PCL is primary restraint to radial deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension
2. PCL is primary restraint to radial deviation with MCPJ in extension, ACL provides restraint to radial deviation with MCPJ in extension
3. ACL is primary restraint to ulnar deviation with MCPJ in flexion, PCL provides restraint to ulnar deviation with MCPJ in extension
4. ACL is primary restraint to radial deviation with MCPJ in flexion, PCL provides restraint to radial deviation with MCPJ in extension
5. PCL is primary restraint to ulnar deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension

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Cases

http://upload.orthobullets.com/cases/1373/screen shot 2013-01-05 at 3.26.43 pm.jpg http://upload.orthobullets.com/cases/1373/screen shot 2013-01-05 at 3.27.35 pm.jpg http://upload.orthobullets.com/cases/1373/screen shot 2013-01-05 at 3.28.33 pm.jpg
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