Metacarpophalangeal ulnar ligament rupture: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*X-ray (perform before joint stressing) | *X-ray (perform before joint stressing) | ||
** | **There is a high association with avulsion fractures from insertion of UCL into proximal phalanx | ||
**Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture | **Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture | ||
*Apply radial stress to the thumb with MCP in partial flexion | |||
*Compare relative laxity to other thumb. | |||
*>35 degrees of joint laxity or 15 degrees of releative laxity compared to other thumb is diagnostic of a complete UCL rupture<ref>Ritting A et al. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 20110;20(2):106-112</ref> | |||
=== | ===Stener Lesion=== | ||
This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Patients will require surgical repair<ref>Bowers WH, Hurst LC. Gamekeeper's thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59(4):519-524</ref> | |||
==Management== | ==Management== | ||
Revision as of 14:42, 24 November 2015
Background
- Also known as "Gamekeeper's thumb" or "Skier's thumb"
- Ulnar ligament ruptures at insertion into proximal phalanx (due to radial deviation of MCP)
- If left untreated, it will causes decreased thumb adduction and inability to perform opposition.
- The mechanism of injury is usually a rapid deceleration while holding onto an objection (such as a ski pole)
Clinical Features
- Swelling and localized tenderness over ulnar border of joint
- Weakness of pinch
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Diagnosis
- X-ray (perform before joint stressing)
- There is a high association with avulsion fractures from insertion of UCL into proximal phalanx
- Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
- Apply radial stress to the thumb with MCP in partial flexion
- Compare relative laxity to other thumb.
- >35 degrees of joint laxity or 15 degrees of releative laxity compared to other thumb is diagnostic of a complete UCL rupture[1]
Stener Lesion
This phenomenon occurs when there is a UCL tear that results in entrapment of the adductor pollicis aponeurosis within the UCL. Patients will require surgical repair[2]
Management
- Partial rupture
- Immobilize in thumb spica for 4wk
- Full rupture
- Referral within 1wk
Disposition
- Outpatient treatment
See Also
External Links
Video
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