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
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