Skier's Thumb Research Articles

A Surgical Approach to a Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury without Dividing the Adductor Aponeurosis.

An injury to the ulnar collateral ligament (UCL) of the metacarpophalangeal joint (MCPJ) of the thumb is a common injury, widely referred to as a skier's thumb. The rupture usually occurs at the distal insertion. In the classical technique, the adductor aponeurosis is divided to access the torn UCL and the MCPJ and repaired after ligament repair/reinsertion. We describe a surgical approach to the UCL that does not require division of the adductor aponeurosis. Level of Evidence: Level V (Therapeutic).

New Diagnostic-Based Systematic Classification for Skier's Thumb Injuries: A Revision That is Needed

Abstract Background Acute injuries to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint (MCPj), commonly referred to as Skier’s thumb injuries, can be further categorized into different types based on bone lesions and joint instability. However, none of the existing classifications encompasses all types and combinations of injuries. A unified classification system that provides direct treatment recommendations for each type is required, particularly for cases with no clear indications. Aims To develop a new classification system for acute UCL injuries of the first MCPj that comprehensively defines all possible combinations and types of injuries and facilitates treatment decision-making for each specific type in daily clinical practice. Methods The retrospective study included patients with acute UCL lesions who underwent conservative or operative treatment at our clinic between 2018 and 2023. This classification addresses ligamentous or osseous lesions, fracture fragment size and dislocation, ligament configuration (e.g. Stener lesions), and joint stability. Correlated radiography, ultrasonography, MRI, and intraoperative findings were used to define all combinations and variants of skier`s thumb injuries. Pre-therapeutic joint stability was characterized according to the criteria established in the literature. Dislocation criteria for bone lesions were defined in a preliminary observer trial. The classification was applied by three hand surgeons with different training levels. Treatment applied and a 3-months follow-up was documented. Results In 213 patients with acute UCL tears, the new classification was consistently applied, and the treatment derived was largely aligned with the recommendations in the literature for both absolute and relative indications for splint or operative therapy. The vast majority of the patients were stable after 3 months. Conclusion This new classification is the first to combine the clinical and radiological aspects of skier`s thumb injuries into one classification and encompasses all variants. It is comprehensive, can be easily applied retrospectively, and provides clear treatment recommendations in most cases.

Treatment of Ulnar Collateral Ligament Fracture-Avulsion of the Thumb: A Case Report

Ulnar collateral ligament (UCL) injuries of the thumb, often termed "gamekeeper's thumb," can result from falls or repetitive thumb abduction, predominantly affecting males. The severity ranges from stretching (grade I) to complete tearing (grade III), occasionally accompanied by avulsion fractures. Surgical intervention is advocated in some cases to restore joint stability and prevent osteoarthritis. The authors present a case report of a 51-year-old male with a displaced avulsion fracture at the UCL's distal attachment. Surgical treatment was performed. A lazy S dorsomedial approach over the first metacarpophalangeal joint was made, with careful protection of the dorsal cutaneous branches of the radial sensory nerve. An anatomic reduction of the fracture was achieved with the use of a suture passing k wire that was inserted through the avulsed fragment and then the phalanx and a non-absorbable suture (fiberwire) was passed. The free ends of the suture were securely tied on the distal radial side of the proximal phallanx, ensuring a stable fixation. Postoperative immobilization and rehabilitation led to a successful outcome, with the patient returning to work within 6 weeks, without complications. This case underscores the importance of surgical techniques in managing UCL injuries, emphasizing the restoration of joint stability to prevent long-term complications such as osteoarthritis, chronic pain and stiffness. The described method offers a viable option for treating UCL avulsion fractures, facilitating early recovery and preserving joint function.

A Comparative Review of Surgical and Conservative Outcomes in Pediatric Gamekeeper's Thumb

A Comparative Review of Surgical and Conservative Outcomes in Pediatric Gamekeeper's Thumb

A case series of Stener’s lesion of the first metacarpophalangeal joint

Ulnar collateral ligament (UCL) injuries have a high prevalence however; these are usually being missed in the initial clinical evaluation. Depending on the chronicity of the injury there are two acronyms for UCL tear. One is the skier's thumb and the other is the gamekeeper's thumb. If the UCL of the first metacarpophalangeal joint (MCP joint) has a complete tear with entrapment of aponeurosis of adductor pollicis muscle between the MCP joint and torn ligament, is called a Stener’s lesion. This is a rare clinical entity that requires early surgical correction because of entrapment. The mechanism of injury is the coerced abduction of the thumb from the index finger, causing ligament tears or sprain with or without ensuing avulsion fracture. The incidence of Stener’s lesions associated with UCL rupture has been reported to be up to 52% per intra-operative finding. In Stener’s lesions, the UCL tears from the base of the proximal phalanx (PP) then retracts proximally and displaces superficial to the adductor pollicis. Here we are presenting four cases of Stener’s lesions, with the usefulness of magnetic resonance imaging (MRI) in diagnosing this entity, which can prevent possible long-term complications such as chronic pain, joint degeneration, and joint instability.

Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation

First described in 1955 as "gamekeeper's thumb," injuries to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint are common and can cause pain and instability, especially during key pinch and grasp. Although primarily diagnosed on physical examination, stress radiographs, ultrasonography, and magnetic resonance imaging can be used to diagnose UCL injuries and distinguish partial from complete tears. If complete rupture occurs, the adductor aponeurosis can become interposed between the retracted UCL stump and its insertion on the proximal phalanx, known as a "Stener lesion." When instability persists after a trial of nonsurgical management or in the setting of complete rupture, there are various methods of repair or reconstruction. Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament. Recently, suture tape augmentation has been used for the repair or reconstruction with excellent short-term results and earlier return to function, although there is a paucity of literature on longer term outcomes. The various methods of surgical treatment yield excellent outcomes with a low incidence of complications.

Skier's thumb - a case report

Skier's thumb - a case report

Traumatic Great Toe MCL Avulsion in Professional Athlete Treated Surgically with MCL Repair with Suture Tape Augmentation Allowing Rapid Return to Sport

Category: Sports; Midfoot/Forefoot; Trauma Introduction/Purpose: Acute medial collateral ligament (MCL) tears of the great toe metatarsophalangeal joint (MTPJ) are a rare occurrence. There is minimal literature existing regarding both operative and non-operative management of this pathology, also known as 'traumatic bunion' due to its low incidence. The closest analog is a traumatic ulnar collateral ligament (UCL) rupture in the hand (Skier's thumb). Suture anchor repair with an internal brace has proven to be an effective treatment for thumb UCL tears with rapid rehabilitation and early range of motion. This method has not yet been reported in literature for a weightbearing joint such as the hallux MTPJ. We present a case report for a professional surfer with traumatic great toe MCL avulsion with surgical technique allowing rapid return to sport. Methods: We present a case report of a novel technique for this rare traumatic MCL avulsion. Surgical management of the great toe MCL was performed utilizing a pre-loaded interference screw to fixate suture at the MCL origin with suture tape augmentation. A mid-axial medial approach was used with L-shaped capsular flap to expose the MCL. 3-0 braided suture was passed through the proximal avulsed MCL. A drill tunnel was prepared at the MCL origin, and the MCL was repaired to its anatomic origin with an interference screw technique for knotless technique. The interference screw was preloaded with suture tape. The suture tape from the interference screw was passed extra articular and the capsule was repaired. The sutuer tape was then inserted into the MCL insertion on the distal phalanx using a small interference screw and drill tunnel for a suture tape augmentation while the toe was held in neutral MTPJ position. Results: He was made weightbearing as tolerated in a CAM boot post-operatively. Immediate active great toe MTPJ motion was permitted. At 2 weeks post-op, sutures were removed, and he was allowed self-directed passive range of motion of the toe, with continued weightbearing as tolerated in the boot. All restrictions were lifted at 4 weeks for a return to play protocol and the patient resumed surfing immediately at that time. His last follow up appointment was at 3 months post-op, at which time he had resumed full activity, had no deformity recurrence, no pain, and his range of motion was symmetric to the contralateral foot. The patient was able to compete at full activity in a national tournament to continue the professional tour at 3 months post- operatively. Conclusion: This report demonstrates a novel surgical technique for the treatment of a rare traumatic MCL avulsion of the great toe (the 'traumatic bunion'). In this case of great toe MCL repair in a professional surfer, we utilized a knotless technique to repair the MCL to it's anatomic origin and also provide suture tape augmentation to allow rapid rehabilitation. This report demonstrates rapid return to sport, an excellent outcome, easy rehabilitation, and straightforward surgical technique. More research will be needed to demonstrate the success of this technique in a broader population.

Mathematical model creation for Reducing damages in basketball players

Introduction: Hand and wrist stability are critical for optimal upper extremity function. Instability occurs when injury or a pathological condition alters balance, typically in the basketball players and handball players. Injury also can occur whenever the ligaments are subjected to tensile forces that exceed their physiological capacities. For example, thumb is stable in extension when ulnar collateral ligament sprain or tear and gamekeepers thumb injury happen but it appears to be unstable inflexion. The goal was to decrease this injury to a region. Materials and Methods: Precise hand positioning on 5 Basketball is drawn for guides to teach proper shooting technique by using Morley theorem proof results (figure1). Lemma: if points z. y. z. y follow conditions: zy = zy = yz. yzy = zyz = π − 2α > π then will be located on a circle. Circleayzyz is as a Basketball and points are as Head of distal phalanges. If angle size between finger number 1 and finger number 2 and finger number 5 equals3α , this size between finger number 2 and finger number 3 and between finger number 3 and finger number 4 equals2α , It is same for between finger number 4 and finger number 5; as a result, force that comes from the Basketball brings the least damage in the fingers and thumb. Results: The alpha angle size is different in Athletes; but according to the theorem, it must be less thanπ. Our Studies have found alpha angle normal size (about15°) and relation between alpha angle size and Distance between fingers in basketball players follow: sin (π − α) +3 1 sin(π−α)3. When the alpha equals 15, the equation is 2.12 cm, by considering this result shooting range increase and damages is in lowest point. Conclusion Results also can be used in evaluations. ligament laxity maybe reduced by using Mathematical model.

Continuing to work with a sterile thumb splint: A case report

Nonoperative treatment of an injured ulnar collateral ligament of the thumb metacarpophalangeal (MCP) joint (skier's thumb without a Stener lesion) is managed by immobilization. A splint is applied on the radial side with the thumb in slight flexion to immobilize the MCP joint and allow motion in the interphalangeal joint. Thermoplastic splints are mainly used for daily activities with the advantage of custom fabrication for optimal comfort. To immobilize the thumb during surgical procedures performed by an orthopedic surgeon, splints made of sterilizable materials are needed but not yet available to our knowledge. We present the case of a 36-year-old orthopedic surgeon diagnosed with skier's thumb, and the development and application of a reusable, patient-specific (i.e., the orthopedic surgeon) splint to immobilize the thumb MCP joint in a sterile environment so the surgeon could continue working.

Injuries to the Collateral Ligaments of the Metacarpophalangeal and Interphalangeal Joints: Sonographic Appearance.

Injuries to the collateral ligaments of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are commonly encountered in both athletes and nonathletes. They require prompt evaluation to ensure proper management and prevent loss of joint motion and permanent disability. Imaging is often required to confirm the diagnosis and assess injury severity. This review article aims to provide physicians with guidelines for sonographic assessment of the collateral ligaments of the MCP and IP and related injuries. Sonographic features of ligament injuries ranging from sprains and partial-thickness tears to full-thickness tears are described. Specific lesions of the ulnar collateral ligament of the thumb MCP joint, such as gamekeeper's thumb, skier's thumb, and Stener lesions, are also included. In conclusion, sonography is effective in evaluating the collateral ligaments of the MCP and IP joints and related injuries and represents a valuable tool for diagnosis.

Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series.

Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.

Current status of ultrasonography of the finger.

The recent development of advanced high-resolution transducers has enabled the fast, easy, and dynamic ultrasonographic evaluation of small, superficial structures such as the finger. In order to best exploit these advances, it is important to understand the normal anatomy and the basic pathologies of the finger, as exemplified by the following conditions involving the dorsal, volar, and lateral sections of the finger: sagittal band injuries, mallet finger, and Boutonnière deformity (dorsal aspect); flexor tendon tears, trigger finger, and volar plate injuries (volar aspect); gamekeeper’s thumb (Stener lesions) and other collateral ligament tears (lateral aspect); and other lesions. This review provides a basis for understanding the ultrasonography of the finger and will therefore be useful for radiologists.

Hand injuries in mountain sports

Apart from clean cut finger amputations, every kind of hand injury can be seen in mountain and winter sports but only skier's thumb and injuries of the pulley system in sport climbers are seen in a greater number of cases. Nevertheless, these two common injuries as well as the rare frostbite of the fingers are often underdiagnosed or overdiagnosed as well as undertreated or overtreated. This paper describes the diagnostics and treatment of skier's thumb, injuries of the pulley system in sport climbers and frostbite of the fingers. Before checking the metacarpophalangeal (MP) joint of the thumb for stability, radiographs should be taken to exclude a bony avulsion of the ulnar collateral ligament in skier's thumb. If there is no bony ligament avulsion further diagnostic procedures, e.g. ultrasound, are recommended to prove or exclude a Stener lesion, which is an absolute indication for operative treatment together with a dislocated bony ligament avulsion. To quantify the severity of a lesion of the pulley system ultrasound and magnetic resonance imaging (MRI) are needed. Most lesions of the pulley system can be treated conservatively. Only multiple pulley ruptures or isolated ruptures associated with a lesion of the lumbrical muscles or collateral ligaments require operative treatment. As long as there is no infection amputation should be done as late as possible in frostbite of the fingers because the extent of the frostbite can rarely be correctly estimated. Most cases of skier's thumb as well as lesions of the pulley system can be treated non-operatively but precise diagnostics are needed.

The Athlete's Hand: Ligament and Tendon Injury

Hand injuries are common, accounting for up to 20% of emergency department visits nationwide. An understanding of the complex and detailed anatomical relationships of small joints facilitates the accurate diagnosis of many common sports-related injuries of the hand. We review the common ligamentous and tendinous injuries of the hand including collateral ligament injuries, gamekeeper's thumb, extensor mechanism injuries, pulley injuries, boutonniere deformities, and mallet and jersey lesions. The mechanism of injury, clinical presentation and treatment, pertinent anatomy, and imaging findings are discussed.

Can clinical examination cause a Stener lesion in patients with skier's thumb?: A cadaveric study

Approximately one-third of all injuries of the upper limb and 7% of all injuries in skiing affect the ulnar collateral ligaments of the thumb metacarpophalangeal joint (skier's thumb). In some patients the collateral ligaments are displaced proximally over the adductor aponeurosis, resulting in a so-called Stener lesion. In these cases surgical treatment is indicated. We hypothesized that a Stener lesion could be provoked by clinical stability testing in patients with a skiers thumb and performed a cadaveric study on 10 Thiel fixated cadaver hands. For clinical stability testing, the thumb was manually deviated in radial direction in both 30° flexion and extension of the MP-joint. It was performed with maximum strength by two hand surgeons after sequential detachment of the ulnar collateral ligaments. After every sequence, it was assessed if the clinical stability testing had caused a Stener lesion. All of the 10 cadavers showed identical results while testing the clinical stability. A decreased stability was only found after cutting both parts of the ulnar collateral ligaments. A Stener lesion could not be provoked in any of the cadavers at any time by clinical stability testing. Summarizing our findings we conclude that a proper performed clinical stability testing of the thumb MP joint is a safe maneuver, which does not lead to a Stener lesion in patients with skier's thumb.

Sports Related Hand Injuries in Hong Kong

This study attempted to review the incidence of sports related hand injuries in one of the regional hospitals in Hong Kong and to study the intervention method used in this diagnostic group. A retrospective study was conducted in 2009 to review all the referrals from the Department of Accident and Emergency to the Occupational Therapy Department. Injuries related to sports activities or exercises were selected and their demographic information including gender, age, types of sports engaged in, and types of injuries were recorded. A total of 596 patients were recorded and 62 of them were identified to have sports related injuries of the hand. Types of injuries included proximal interphalangeal joint volar plate injuries, phalangeal fractures, metacarpal fractures, mallet fingers and gamekeeper's thumb. Twelve different types of sports related injuries were identified, with most injuries caused by contact sports, namely basketball (44%) and football (26%). All patients were treated with standardized splintage and mobilization programme. Seventy-eight percent of the patients completed full course of the therapy and most of them had very satisfactory results in restoration of hand function. Residual problems such as joint stiffness, limitation of full range of motion were found only in five cases. Most of them returned to their previous sports with preventive gadgets. The management of various hand injuries was briefly discussed. Incidence of sports related hand injuries appear to be on a rising trend and there should be special training for occupational therapists to provide quality therapy services to those injured.

Sports Related Hand Injuries in Hong Kong

Objective This study attempted to review the incidence of sports related hand injuries in one of the regional hospitals in Hong Kong and to study the intervention method used in this diagnostic group. Methods A retrospective study was conducted in 2009 to review all the referrals from the Department of Accident and Emergency to the Occupational Therapy Department. Injuries related to sports activities or exercises were selected and their demographic information including gender, age, types of sports engaged in, and types of injuries were recorded. Results A total of 596 patients were recorded and 62 of them were identified to have sports related injuries of the hand. Types of injuries included proximal interphalangeal joint volar plate injuries, phalangeal fractures, metacarpal fractures, mallet fingers and gamekeeper's thumb. Twelve different types of sports related injuries were identified, with most injuries caused by contact sports, namely basketball (44%) and football (26%). All patients were treated with standardized splintage and mobilization programme. Seventy-eight percent of the patients completed full course of the therapy and most of them had very satisfactory results in restoration of hand function. Residual problems such as joint stiffness, limitation of full range of motion were found only in five cases. Most of them returned to their previous sports with preventive gadgets. The management of various hand injuries was briefly discussed. Conclusion Incidence of sports related hand injuries appear to be on a rising trend and there should be special training for occupational therapists to provide quality therapy services to those injured.

Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint

Injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is a common entity encountered by the sports physician and orthopedic surgeon. The term "gamekeeper's thumb," which is sometimes used incorrectly to mean any injury to this ligament, refers to a chronic injury to the UCL in which it becomes attenuated through repetitive stress. In contrast, the term "skier's thumb" refers to an acute ligament injury as seen in skiers who fall on an abducted thumb or athletes who sustain a valgus force on an abducted thumb. If the patient allows a clinical examination, valgus stress testing can diagnose a complete UCL rupture when there is no solid endpoint with the thumb held in 30 degrees of MCP flexion and with the thumb held in extension. In cases with complete UCL tears, operative treatment has been shown to produce excellent results and is recommended. If there is a firm endpoint to valgus stress testing, a partial UCL tear is diagnosed and nonoperative treatment usually favored.

Ultrasound of the Hand and Wrist

Hand surgeons routinely evaluate focal abnormalities of the hand and wrist using magnetic resonance imaging (MRI). Many do not appreciate that ultrasound can provide a time- and cost-effective alternative and can provide unique dynamic information that is not available from an MRI scan. A partial list of conditions in which ultrasound has shown utility include tendon ruptures, lacerations and pulley injuries, gamekeeper's thumb, occult fractures, carpal tunnel syndrome, and foreign bodies. It is also useful for the characterization of masses of the hand and wrist (solid vs cystic, vascular vs avascular or hypovascular) and in determining the presence of fluid and tenosynovium within the flexor tendon sheath and dorsum of the hand.