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.
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