eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Gamekeeper Thumb: Follow-up
Updated: Apr 9, 2008
Follow-up
Further Outpatient Care
- Conservative management with a functional brace
- Once the cast or splint has been removed, a period of active MCP flexion exercises should be followed with gradual return to activities.
- Patients should be advised to avoid heavy gripping or grasping until the grip strength has returned to normal.
- Surgical management
- Patients should be placed in a short arm thumb spica cast for 4 weeks.
- The thumb spica cast and pins (if any were placed) are removed after 4 weeks.
- For the ensuing 2 weeks, a splint that immobilizes the MCP is applied and removed for therapy of the MCP.
- Next is active range of motion of the MCP joint and unrestricted usage is allowed at about 3 months postoperatively.
- Follow-up care should be arranged with an orthopedic or a hand surgeon.
- Surgery may be necessary in patients who do not respond to conservative therapy initially.
Inpatient & Outpatient Medications
- A course of NSAIDs is recommended.
- A brief course of narcotics may be needed to alleviate the acute phase of pain and swelling.
Complications
- Chronic instability is a major complication of UCL rupture. An unstable MCP joint can lead to degenerative joint changes and cause weakness of power grasp as well as decreased dexterity of fine pincher-type movements.
- The most common cause is failure to seek medical attention in a timely fashion or a missed diagnosis.
- Risk factors for chronic instability include the following:
- Larger tears
- Those left untreated or have delayed treatment more than 6 weeks
- Return to play/activities too prematurely
- May even occur after adequate repair
- Stiffness of the metacarpal and interphalangeal joint may be seen, especially following cast removal. Most improve with time and range of motion exercises.
- Transient neurapraxia of the branch of the superficial radial nerve may be a complication after undergoing surgery.
Prognosis
- Most authors agree that early diagnosis is the most important factor that determines the functional outcome.
- Partial ligament tears: Nonsurgical conservative management usually yields thumbs with normal range of motion.
- Complete ligament tears
- Early referral/consultation is indicated, especially if some degree of uncertainty exists about whether a complete UCL tear is present.
- The failure rate is about 50% using conservative treatment with functional bracing and early motion exercises.
- Early surgical intervention—within 3 weeks of injury—has led to good results in the treatment of gamekeeper's/skier's thumb injury. The prognosis may be worse if surgical intervention has been delayed. The anatomy may be too distorted by 6 weeks to permit direct repair; however, studies have reported good results obtainable with late repair or reconstruction.
Patient Education
- Changes in pole design, such as the strapless pole, have not been associated with a decrease in the incidence of gamekeeper's/skier's thumb injuries. If skiers are trained to discard their pole or poles during a fall, the risk might be reduced.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose this ligamentous injury
- Failure to properly treat this ligamentous injury
- Failure to make timely referral to orthopedist or hand surgeon
- Failure to incorporate stress testing with a normal radiograph
- Stress testing with a displaced bone fragment
More on Gamekeeper Thumb |
| Overview: Gamekeeper Thumb |
| Differential Diagnoses & Workup: Gamekeeper Thumb |
| Treatment & Medication: Gamekeeper Thumb |
Follow-up: Gamekeeper Thumb |
| References |
| « Previous Page |
References
Plancher KD et al. Role of MR imaging in the management of "skier's thumb" injuries. Magn Reson Imaging Clin N Am. Feb 1999;7(1):73-84, viii. [Medline].
Hintermann B, Holzach PJ, Schütz M, Matter P. Skier's thumb--the significance of bony injuries. Am J Sports Med. Nov-Dec 1993;21(6):800-4. [Medline].
Abrahamsson SO, Sollerman C, Lundborg G, et al. Diagnosis of displaced ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. May 1990;15(3):457-60. [Medline].
Adams BD, Muller DL. Assessment of thumb positioning in the treatment of ulnar collateral ligament injuries. A laboratory study. Am J Sports Med. Sep-Oct 1996;24(5):672-5. [Medline].
Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br. Feb 1955;37-B(1):148-9. [Medline].
Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical treatment of skier's thumb injuries: case report and review of the literature. Mt Sinai J Med. Sep 2006;73(5):818-21. [Medline].
Fairhurst M, Hansen L. Treatment of "Gamekeeper's Thumb" by reconstruction of the ulnar collateral ligament. J Hand Surg [Br]. Dec 2002;27(6):542-5. [Medline].
Fricker R, Hintermann B. Skier's thumb. Treatment, prevention and recommendations. Sports Med. Jan 1995;19(1):73-9. [Medline].
Jones MH, England SJ, Muwanga CL, Hildreth T. The use of ultrasound in the diagnosis of injuries of the ulnar collateral ligament of the thumb. J Hand Surg [Br]. Feb 2000;25(1):29-32. [Medline].
Musharafieh RS, Bassim YR, Atiyeh BS. Ulnar collateral ligament rupture of the first metacarpophalangeal joint: a frequently missed injury in the emergency department. J Emerg Med. Mar-Apr 1997;15(2):193-6. [Medline].
Newland CC. Gamekeeper's thumb. Orthop Clin North Am. Jan 1992;23(1):41-8. [Medline].
Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. Jul 2006;25(3):527-42, vii-viii. [Medline].
Pichora DR, McMurtry RY, Bell MJ. Gamekeepers thumb: a prospective study of functional bracing. J Hand Surg [Am]. May 1989;14(3):567-73. [Medline].
Richard JR. Gamekeeper's thumb: ulnar collateral ligament injury. Am Fam Physician. Apr 1996;53(5):1775-81. [Medline].
Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb: clinical and anatomic study. J Bone Joint Surg [Br]. 1962;44:869-79.
Further Reading
Keywords
skier thumb, skier's thumb, injury to ulnar collateral ligament, UCL, hyperabduction of thumb, gamekeeper's thumb
Follow-up: Gamekeeper Thumb