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http://upload.orthobullets.com/topic/6040/images/ucl avulsion.jpg
http://upload.orthobullets.com/topic/6040/images/stener lesion.jpg
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 attachment 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 and proper 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 attachment 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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