ORTHOPEDIC DISEASES & CONDITIONS:

SPAIN& STRAIN of ligaments:

 HAND/ FINGERS/ THUMB/ LIGAMENTS/ METACARPOPHALANGEAL LIGAMENT SPRAIN/UCL OF MPJ
 ETIOLOGIC CONSIDERATION: ACCIDENTS AND INJURIES/ SPORT INJURIES
 ACUTE MEDICAL CONDITION: ACCIDENT& INJURY> MAINLY SPORT RELATED TRAUMA
 CHORONIC CONDITION: TRAUMATIC> MINOR> JOB RELATED> CHRONIC
Injuries to the ulnar collateral ligament (UCL) of the thumb were first recognized as an occupational
condition in European gamekeepers.
ETIOLOGY: TRAUMATIC INJURY TO THE “UCL”
 MINOR& MULTIREPETITIVE TRAUMA:
 Ex: repetitively wringing the necks of game (eg, chickens) between their thumb and index
finger>Chronic stretching
 MAJOR AND ACUTE TRAUMA
Sprained Thumb or SKIER’S THUMB or GAMEKEEPER’S THUMB
Both terms are often used interchangeably.
Skier’s thumb refers to the cause as being acute injury.
“FUNCTIONAL ANATOMY”
The MCP joint of the thumb is primarily stabilized by the UCL
SPORT-SPECIFIC BIOMECHANICS:
Damage may also result from a combination of torsion, abduction, and hyperextension at the first MCP joint.
Depending on the degree of impact of these forces at the MCP joint, the UCL may either tear partially or
completely.
MECHANISM OF INJURY:
1. FOOSH injury
2. Football players>while making a tackle
3. skiing injuries> the strap or sword grip lies across the palm and transmits the damaging force to the
thumb during a fall.
4. athletes who handle balls
5. among those who use sticks
FORCES REQUIRED: an acute abducting (radially directed) force upon the thumb. a combination of torsion,
abduction, and hyperextension at the first MCP joint.
This type of chronic injury is known as a “gamekeeper’s thumb.”
Sprained thumbs are also common in skiers, and in athletes who participate in sports that involve catching
and throwing a ball, like football, baseball, and basketball.
Falling on the ski slopes with your hand strapped to a ski pole is a common cause of injury to the ulnar
collateral ligament.
The ligament can also be injured more gradually, over time, from repetitive grasping or twisting activities.

1. SKIER’S THUMB
Gamekeeper’s thumb specifically refers to the cause being associated with a chronic injury to the UCL in
which it became attenuated through repetitive stress.
Ligaments are strong, fibrous tissues that connect bones to other bones.
The ligaments in the thumb help keep the bones in proper position and stabilize the joint.
The most common ligament to be injured in the thumb is the ulnar collateral ligament.
The “UCL of the thumb” is attached to the middle joint of the thumb (the metacarpophalangeal or MCP joint).
The ulnar collateral ligament can tear in different ways.
It may be pulled off its attachment at the base of the first bone (the proximal phalanx) in the thumb or from
its origin on the metacarpal bone.
It can also be torn through its middle, although this is less common.
UCL keeps your thumb stable so that you can pinch and grasp things.
Skier's thumb is an acute partial or complete rupture of the ulnar collateral ligament (UCL) of the thumb’s
metacarpophalangeal joint (MCPJ) due to a hyperabduction trauma of the thumb.
when the ligaments that support the thumb stretch beyond their limits or tear a sprained thumb occurs.
The severity of sprain and tear can range from a stretch or tiny tear in the fibers that make up the ligament to
a complete tear through the ligament or through its attachment to the bone.
Any strong force that bends the thumb backwards, away from the palm of the hand, can stretch or tear the
ulnar collateral ligament.
This most often occurs by falling onto an outstretched hand.
This usually happens when a strong force bends the thumb backwards, away from the palm of the hand.
The most common way for this to occur is by falling onto an outstretched hand.
Most thumb sprains involve the ulnar collateral ligament.
The U.C.L is located on the inside of the knuckle joint.
A tear to this ligament can be painful and may make your thumb feel unstable.
It may also weaken your ability to grasp objects between your thumb and index finger.
Treatment for a sprained thumb usually involves wearing a splint or cast to keep the thumb from moving
while the ligament heals.
For more severe sprains, surgery may be needed to restore stability to the joint.
UCL damage caused by Chronic injury may have a serious risk of disabling instability, pinch strength, and
pain-free motion if not treated adequately.
In 64–87% of total UCL tears, a Stener lesion can occur.
A Stener lesion occurs when the adductor aponeurosis becomes interposed between the ruptured UCL and its
site of insertion at the base of the proximal phalanx.
Hence making it impossible for the loosened ligament to reconnect with the site of insertion, necessitating
surgery.
PROGNOSIS:
 When properly treated
 If left untreated or in poorly managed cases

1. SKIER’S THUMB
“SPRAINED THUMB” is graded, depending on the degree of injury to the ligaments.
When the ligament is completely torn or is pulled off its attachment to the bone (GRADE3), injuries require
medical or surgical care.
Sometimes an avulsion fracture may happen.

Depending on the severity of the sprain, pain may or may not occur at the time of the injury.
You may have bruising, tenderness, and swelling around the base of your thumb, near the palm.
The end of the ruptured ligament may cause a lump or swelling on the inside of the thumb If the ulnar
collateral ligament is completely torn.
Your thumb joint may also feel loose or unstable.
You may have difficulty grasping items between your thumb and index finger.
It is important for your doctor to evaluate even a mild thumb sprain if it does not improve quickly.
Proper diagnosis and treatment of a thumb injury is necessary to avoid long-term complications.
Long term complications include: chronic pain, instability, and arthritis.
COMPLICATION: instability at the first metacarpophalangeal (MCP) joint (UCL laxity and thumb instability)
MEDICAL HISTORY is very important, ask about WHEN, HOW the injury occurred.
Also ask about the symptoms.
EXAMINATION is required to help determine if the ulnar collateral ligament is partially or completely torn.
Test the stability of the MCP joint by moving your thumb in different positions.
If the joint is loose and unstable, it is an indication that the ligament may be completely torn and needs to be
surgically fixed.

X-rays provide images of dense structures.

Your doctor may order x-rays of your thumb and hand to ensure that you do not have an avulsion fracture or
any broken bones.
He or she may also take an x-ray of your uninjured thumb to compare it to the injured thumb.
A special type of x-ray, called a stress x-ray, may also be ordered.
During this test, your doctor will apply tension to your thumb while it is being x-rayed to learn more about
the stability of the MCP joint.
If the test causes pain, you may be given an injection of a local anesthetic.

CAUSE: accident and sport injury, most often due to a skiing accident.
PATHOLOGY: an injury to the ulnar collateral ligament (UCL) of the thumb
Diagnosis: HOW IS THIS CONDITION DIAGNOSED?
Clinical examination remains the criterion standard in the diagnosis of a UCL rupture of the thumb.
TREATMENT: HOW IS THIS MEDICAL CONDITION MANAGED?
 CONSERVATIVE Mx?
 SURGICAL Mx?

1. SKIER’S THUMB
The type of management is mainly selected according to the GRADING of the condition.
GRADE 1&2 skier's thumbs and incomplete UCL ruptures can be treated conservatively with proper
immobilization.
SURGICAL MANAGEMENT:
 Complete rupture of the UCL, as evidenced by joint instability
 UCL damage WITH ANY ACCOMPANYING FRACTURE that is displaced, rotated, or intra-articular
 Presence of a Stener lesion
 Grade 3 classification
SIGNIFICANCE> EPIDEMIOLOGY
WHAT PERCENTAGE OF ALL SKIING INJURIES IS THIS CONDITION?
WHAT PERCENTAGE OF THE GP ENCOUNTERS HAVE THIS CONDITION?
PEOPLE WITH THIS CONDITION USUALLY SEEK MEDICAL ATTENTION IN WHICH CARE SETTING?
This condition is the most common ……………………..

1. SKIER’S THUMB