Andrew Traber

Jaime Miller

Radiographs

What is gamekeepers thumb? It’s a sprain to the thumb’s ulnar

collateral ligament This use to occur when gamekeepers

broke the neck’s of rabbits by using the thumb and index finger against the ground

Mechanism of Injury

Falling on an outstretched hand Valgus force on the thumb while the

thumb is abducted Generalized ligamentous laxity

Signs and Symptoms

Pain and inflammation at the ulnar site of the MCP joint

Ecchymosis Loss of ROM compared bilaterally Unstable joint Inability to pinch

Therapeutic Modalities

Ice cup massage to decrease pain and inflammation

Paraffin bath used to increase blood flow to the area

Ultra Sound to decrease pain and edema assuming there is no avulsion fx.

Stener Lesion

Distal attachment of the UCL is avulsed from the proximal phalanx of the thumb

The avulsed part then gets trapped under the adductor apponeurosis

Lifestyle:

22 year old male collegiate football offensive lineman

Plays about six times a week for about two hours a each day

Has PH of thumb problems in the past

Surgical Technique Incision is made on the mid-lateral aspect of the

ulnar side of thumb The incision curves over the MP joint and extends

proximal to the to the extensor pollicus longus tendon.

The adductor aponeurosis is identified and then detached from the EPL.

The adductor aponeurosis is then left alone until it’s time to close the wound

Surgical Technique

After the add. Aponeurosis is detached the UCL is now visible.

If the tear is unable to hold a suture a pull out wire technique is then used.

If the ligament is torn at the midpoint sutures are placed with the MCP joint flexed at 15 to 20 degrees of flexion

Surgical Technique

For chronic instability:

A reconstruction is done by using a slip of the APL tendon.

The tendon graft is fed through holes and secured above the joint.

Postoperative Management/Rehabilitation For the first 3-4 weeks the patient is put

in a short arm thumb spica cast. The cast then can be removed and the

pt is put in a thumb spica splint. Patient is advised to only take the splint

off for hygiene and for rehab for the next 2 weeks.

Postoperative Management and Rehabilitation The first 4 weeks of rehabilitation will

just be ROM and strengthening of the IP and MCP joints of the other 2nd -5th Digits.

We will also be working on core strengthening and cardiovascular conditioning with our athlete while he is still in the cast

Postoperative Prevention

Flex-a-Grip