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Ulnar Collateral Ligament Surgery Thumb

Ulnar Collateral Ligament Injuries Of The Thumb: Symptoms And Treatment

Thumb UCL Repair With InternalBrace Ligament Augmentation Procedure

A gamekeeper’s thumb, also called a skier’s thumb, is an injury to one of the important ligaments at the base of the thumb joint. The injury involves the ulnar collateral ligament of the thumb.

The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. This ligament prevents the thumb from pointing too far away from the hand. An injury to the ulnar collateral ligament occurs when this structure is stretched too far.

The two common descriptive terms for injuries to the ulnar collateral ligament are:

These names are often used interchangeably, although they describe slightly different types of injury.

What Is The Treatment

Historically, the recommended treatment for skiers thumb involved immobilizing the thumb in a cast for four to six weeks. This option may work if the ligament injury is minor. In the majority of cases, however, surgery to repair the UCL is the treatment of choice. UCL repair is a routine outpatient procedure in which the surgeon reattaches the UCL and anchors it with a screw to hold it in place as it heals.

How Is Gamekeepers Thumb Diagnosed

Early diagnosis is important in any hand injury to prevent possible long-term effects. In addition to a comprehensive history and review of symptoms, the physician will perform a physical examination of both hands and may order imaging test to confirm diagnosis. The doctor may manipulate the thumb in comparison to the opposite thumb to determine if there is any laxity. This may be done under local anesthetic since it can be very painful. X-rays are used to visualize the bones and rule-out possible fractures. MRI and ultrasound may be ordered to observe the severity of soft tissue damage.

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Type Of Study/level Of Evidence

Am J Sports Med.J Hand Surg Br.Ann Plast Surg.

  • McCormack II, R.R.

J Hand Surg Am.Am J Sports Med.

Plast Reconstr Surg.J Hand Surg Asian Pac Vol.Orthop J Sports Med.

Acta Chir Scand.J Bone Joint Surg Br.

J Bone Joint Surg Am.J Bone Joint Surg Am.Arthrosc Tech.J Bone Joint Surg Am.Arthrosc Tech.Orthop Rev.Hand .J Hand Surg Am.J Hand Surg Asian Pac Vol.Tech Hand Up Extrem Surg.

Citation Doi & Case Data

Unraveling the UCL Injury of the Thumb

Citation:DOI:see full revision history

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Tearing of the ulnar collateral ligament is present. The adductor aponeurosis remains superficial to the ulnar collateral ligament.

Intrasubstance abnormal increased fluid signal also is seen along with the ulnar side of the A1 pulley due to annular pulley partial tear.

The fluid-filled defect at the insertion part of the radial collateral ligament dorsal component near to the base of the proximal phalanx is related to a partial tear.

Bone marrow edema/bruise is seen at the first metacarpal head and proximal phalanx base.

Soft tissue edema is depicted around the first MCP joint and thumb proximal phalanx.

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What Causes A Ucl Injury In The Thumb

Most often, injuries occur during sport or recreational activities, such as

In fact…any extreme force to the thumb in the opposite direction can cause a sprain or strain, but injuries can also occur as a result of

  • or jamming the thumb at a hard surface,
  • or the thumb catching onto something that pulls the thumb in the opposite direction

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Welcome to Davis and DeRosa Physical Therapy’s patient resource about Ulnar Collateral Ligament Injuries of the Thumb.

Injury to the ulnar collateral ligament of the thumb is fairly common. This strong band of tissue is attached to the middle joint of the thumb, the joint next to the web space of the thumb. This condition is sometimes called gamekeeper’s thumb because Scottish gamekeepers commonly injured their thumbs as a result of their job.

This guide will help you understand:

  • how the ulnar collateral ligament is injured
  • how doctors diagnose the condition
  • what treatments are available

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Melbourne Hand Therapy Can Help You

Our therapists at Melbourne hand therapy are experts at managing this injury from the acute phase through to the rehabilitation phase. Our aim is to heal the injury as quickly as possible and work with you to ensure you can return to all normal functional activities including work, sports and recreation. We work closely with Melbournes best hand surgeons and can organise a timely referral if surgery is required.

A Comparison Of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair And Local Soft Tissue Advancement

Ulnar Collateral Ligament Injury of the Thumb
  • Louis C. GrandizioCorrespondenceCorresponding author: Louis C. Grandizio, DO, Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 16 Woodbine Lane, Danville, PA 17821.

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About Melbourne Hand Surgery

Website disclaimer: The Melbourne Hand Surgery website is authored by Dr Jillian Tomlinson, a fully qualified plastic, reconstructive and hand surgeon who practices in Melbourne, Australia. The MHS website aims to inform patients and health professionals about hand surgery, illness prevention and the practice philosophy of Dr Jill Tomlinson. The MHS website’s content is designed to complement, not replace, the relationship between a patient and his/her own doctor. The information is not intended to replace the advice of a health professional. The MHS website does not host or receive funding from advertising or from the display of commercial content and there are no conflicts of interest to declare.

When To See A Doctor

If you suffer an injury to your thumb and have symptoms, even if they feel mild, you should see your doctor. Proper treatment of a sprained thumb is important so it doesnt get worse over time. Your doctor will ask questions about your injury, as well as your medical history and physical activity. During the physical exam, he or she will move your thumb in different directions to test the stability of your thumb joint. This movement will help assess if your UCL is stretched or torn. X-rays or other imaging tests may be taken to determine the severity of your injury and whether any bones are broken.

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What Are The Symptoms Of A Ucl Injury In The Thumb

Pain and swelling in the middle joint of the thumb usually occur right after injury, with possible bruising and stiffness in the joint.

With this injury, activities such as holding a drinking glass or writing may be difficult.

Weakness may be a symptom as well, with a decreased ability to grip or pinch any object with the thumb and hand.

Suffering From Skiers Thumb How To Repair Ulnar Collateral Ligament Injury

Ulnar Collateral Ligament Tear of the Thumb (Ski Pole or Gamekeepers ...

DAVENPORT, Iowa -A UCL injury is a tear or other damage to the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. The condition is often referred to as skiers thumb because it is a common injury in the sport.

Dr. Megan Crosmer, MD, Orthopaedic Specialists of Davenport, discusses treatment and surgery options. Crosmer is fellowship trained in hand and upper extremity surgery. Regarding UCL tears, the following questions are answered.

1. What is an ulnar collateral ligament tear of the thumb?

  • Ulnar collateral ligament tear of the thumb is when the ligament on the inside portion of the MCP joint of the thumb is torn from the bone. This ligament is important for pinch strength of the thumb. The tear often occurs as the thumb is pulled outward or with a dislocation of the thumb.

2. How is this diagnosed?

  • History and exam are essential for diagnosis. Patients report an injury to the thumb where the thumb is pulled outwards or to the side, often with resulting pain on the inner portion of the thumb and pain with pinching or gripping activities. Swelling is often present. On exam, there is instability on testing of the ligament of the thumb. X-rays are obtained to evaluate for an underlying fracture. An MRI is often ordered to confirm the diagnosis.

3. How is it treated?

4. What are surgical options?

5. What is advantage to using Arthrex internal brace?

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How Can Dr Knight Help You With Gamekeepers Thumb

Working in sports medicine, Dr. Knight is very familiar with this type of injury and is well versed in its treatment. Upon ascertaining the severity of your case, he will proceed in the manner most appropriate to bring your hand back to full use.

We looking forward to helping you live a more pain free life. Dr. Knight is one of the top hand doctors in Dallas. Visit Dr. John Knight at our Southlake hand and wrist center or Dallas office location.

Thumb Ucl Injuries In Athletes Clayton E Nelson Md

Every season we hear of elite athletes sidelined because of injuries to their hand. Last year Drew Brees and Steph Curry were atop the headlines for notable athletes sentenced to the disabled list while their hands recovered. Although there are many types of hand injuries among athletes, the hand in general is a common site of injury during sports because of its exposed nature and tendency to absorb initial contact. Among injuries to the hand, trauma to the thumb is an all too common site of injury for the competitive athlete.

Whether you are throwing a football or swinging a bat, the thumb is an important stabilizer for pinch and grip activities required by many athletes. The most common athletic injury sustained to the thumb is an injury to the ulnar collateral ligament or frequently called the thumb UCL.

A ligament is a soft tissue structure that connects bones to each other at joints. The thumb ulnar collateral ligament helps connect the thumb to the hand on the side near the index finger at the metacarpophalangeal joint. It functions to allow the thumb to act like a post to stabilize the thumb and aid in pinch and grip.

The UCL tends to be injured when the thumb is pulled in an extreme position away from the hand. This is frequently from contact with another player, the ground, or a ball. An athlete who sustains an injured UCL will have pain, swelling and most notably weakness with grip.

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Thumb Ulnar Collateral Ligament Injury

Ulnar collateral ligament injuries of the thumb can be a cause of pain, instability or weakness of the thumb. Most often people will remember an injury or event that caused the problem, but occasionally it will come on gradually with no identifiable injury. UCL injuries can usually be managed with hand therapy alone but some will need an opinion from a surgeon. It is important to get these injuries treated as they can cause pain and disability in the long-term if they are not managed well.

Pearls And Other Issues

Thumb Ulnar Collateral Ligament Test for UCL Thumb Assessment

When the thumb is placed in extreme abduction or extreme hyperextension, there is a risk of injury to the ulnar collateral ligament, which stabilizes the base of the thumb at the first metacarpophalangeal joint. In one specific group, skiers, this injury is more frequently observed since individuals can fall and strike their thumb on a fixed ski pole. Hence the synonymous term of skiers’ thumb.

Laxity at the first metacarpophalangeal joint on abduction stress testing is suggestive of ulnar collateral ligament injury. Providers should compare to the contralateral unaffected thumb for a baseline reference point.

As with most other musculoskeletal injuries, fractures should be ruled out with standard plain films, but typically imaging modalities are of limited utility acutely in this injury.

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What Does The Surgery Involve

Surgery is performed for complete ligament rupture, and may either be done early or late.

When done early, the surgery generally involves repairing the ligament with sutures.

When performed late, the surgery may involve reconstructing the ligament. The surgery is technically more involved than a simple repair, although the recovery period is generally similar. The ligament is reconstructed by taking tissue from elsewhere, commonly from a tendon in the wrist, and using this to reconstruct the ligament. A temporary wire is more likely to be placed across the joint for a reconstruction. This wire is removed 4-6 weeks after the initial surgery.

In both instances you can expect to be wearing a splint full time for 8 weeks after the initial surgery.

Surgical Techniquethe Treatment Of Chronic Ulnar Collateral Ligament Of The Thumb Injury Using Extensor Pollicis Brevis: Surgical Technique

Chronic rupture of the ulnar collateral ligament of the thumb is a complex lesion that typically results in chronic joint instability, functional limitation in pinch, and persistent pain at the metacarpophalangeal joint of the thumb. Different surgical techniques have been proposed, including tendon graft and transpositions. In this article, we report our experience in treating chronic ulnar collateral ligament injuries using extensor pollicis brevis tendon in a Sakellarides modified technique. During the surgical procedure, we detach the extensor pollicis brevis proximally and drive the tendon through the neck of the first metacarpal and the base of the proximal phalanx to reconstruct the ligament at the ulnar side. In our experience, the surgical technique provides good MCP joint strength and stability and allows a good functional recovery with few postoperative complications. This technique provides good stability of the MCP joint using an absorbable suture and allows early mobilization of the joint with minimal stiffness.

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Ulnar Collateral Ligament Injury Of Thumb

What is is?All joints are stabilised by the soft tissued around the joint. In the small joints of the hand, there are two collateral ligaments on either side of each joint these ligaments stop the joints opening up in the wrong plane. In addition, all joints have a strong sheet of fibrocartilage which resists hyperextension of the joint, or the joint bending backward.

The ulnar collateral ligament of the thumb is particularly important because it allows stable pinch grip. Loss of this ligament, therefore, potentially impairs pinch grip.

How is the UCL injured?The UCL of the thumb is injured as a result of a fall onto the hand, where the thumb is caught and takes the weight of the body through it. The injury is also known as Skiers thumb, since skiers are particularly prone to this mechanism.

What is the treatment?The recommended treatment for this injury depends on its severity.

STABLE INJURIES Partial tears of the ligament can be painful, but the joint remains stable. The injury will usually heal within 4 weeks, with return of normal function by around 6-8 weeks.

A Sprained Thumb Is A Common Injury Among Athletes This Injury Happens When An Ulnar Collateral Ligament Tough And Flexible Tissue That Connect Bones In The Thumb Gets Stretched Too Far Or Tears

UCL injury causes, symptoms, diagnosis, treatment &  prognosis

A sprained thumb is a common injury among athletes. This injury happens when an ulnar collateral ligament tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. This injury is sometimes called skiers thumb because skiers are prone to this injury when they fall with their hand strapped to a ski pole. A thumb UCL injury can be very painful and make the thumb feel unstable. The injury can limit movements, such as squeezing and gripping, needed for many sports.

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How Is A Ucl Injury Treated

The treatment depends on the severity of the injury. Grade 1 and 2 injuries are treated by splinting, generally for eight weeks. Grade 3 injuries are most commonly treated with surgery. In all instances you will be referred to a hand therapist as part of your treatment for splinting, education and rehabilitation.

What Is The Treatment For A Ulnar Collateral Ligament Injury In The Thumb

The doctor will likely order an X-ray of the thumb to rule out a broken bone. The doctor will also test the stability of the thumb with gentle pressure from each side, and compare this to the uninjured thumb.

If there is a sprain to the UCL of the thumb, the physician may prescribe a custom thumb spica splint to rest the joint and ligament for a period of time.

That being said, if the ligament is torn or ruptured, the doctor may recommend surgery to repair the ligament.

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What Can A Hand Therapist Do For Me

Our senior hand therapist can make a custom orthosis to rest the thumb ligament as it heals. While the ligament is healing, we will provide gentle exercises for the other joints of the hand. After the ligament has healed, the therapist will progress exercises to increase function and strength in your hand and thumb.

Custom orthosis to protect UCL injury to the thumb

Patients may also receive the following hand therapy treatment modalities:

Skier’s Thumb: Acute Ucl Injury

Special test – Thumb Ulnar Collateral Ligament Instability test

A skier’s thumb injury is described as an acute injury to the ulnar collateral ligament. When a skier falls with his or her hand caught in a ski pole, the thumb can be bent away from the hand. Because of the shape of the ski pole, the thumb tends to get caught and significant stresses are placed on the ulnar collateral ligament. If the thumb is bent far enough, the ulnar collateral ligament will tear.

While there are many ways to injure the ulnar collateral ligament, a skier’s thumb is the term used for an acute injury to the ligament.

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