Gamekeeper Thumb Workup

  • Author: Michael A Secko IV, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 2, 2011
 

Laboratory Studies

No laboratory tests are necessary for making the diagnosis. Routine preoperative laboratory workup may be required for those cases requiring surgical intervention.

Next

Imaging Studies

Standard radiographs

Posteroanterior (PA), lateral, and possibly oblique radiographs of the thumb are indicated in patients with a suspected gamekeeper's thumb to identify any avulsion fracture at the base of the proximal phalanx.

Findings on plain films are usually normal in the absence of an avulsion fracture. Degenerative joint changes may be seen years later after the initial insult or with chronic injury.

Displaced avulsion fractures or any fracture involving 25% or more of the MCP joint surface requires surgical treatment and should not be manipulated.

Anteroposterior (AP) view: The presence of an avulsion fracture at the base of the proximal phalanx, or less frequently, at the metacarpal head, is suggestive of ligamentous rupture. The persistence of a radially subluxed MCP joint suggests an interposed rupture of the UCL.

Lateral view: A volar subluxation of the MCP joint suggests a tear involving the dorsal capsule and the volar plate indicating probable UCL rupture and instability.

Stress radiographs (+/- local anesthesia)

Valgus stress testing can be performed during plain film radiography after no evidence of bony involvement has been ascertained from standard radiographs. Administration of local anesthesia may be required for proper manipulation.

Radiographs of the MCP join in flexion; extension and lateral stress are useful in grading the severity of MCP joint instability, especially of partial tears of the UCL. As mentioned earlier, greater than 35° of angulation suggests a complete tear.

Other imaging modalities

Arthrography may visualize Stener lesions, but it is an invasive technique, and results are difficult to interpret.

MRI or MR arthrography may be helpful in cases of suspected gamekeeper's thumb by accurately depicting the osseous and soft tissue structures about the MCP joint, including the UCL and surrounding ligaments and tendons. MRI may be impractical and cost prohibitive.

In patients treated surgically, MR imaging resulted in identifying UCL tears with 96% sensitivity and 95% specificity.[1]

In patients treated surgically, ultrasonography had a sensitivity of 83%, specificity 75%, and a positive predictive value of 94%.

For the emergency physician, carrying out these highly specific tests may not be practical. Standard radiographs and adequate physical examination should be enough to determine those cases that necessitate surgical repair.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Michael A Secko IV, MD  Clinical Assistant Instructor, Staff Physician, Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB  Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn

Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Joseph Kim, MD  Chairman, Department of Emergency Medicine, Western Medical Center; Clinical Instructor, University of California at Irvine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br. Feb 1955;37-B(1):148-9. [Medline].

  6. 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].

  7. 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].

  8. Fricker R, Hintermann B. Skier's thumb. Treatment, prevention and recommendations. Sports Med. Jan 1995;19(1):73-9. [Medline].

  9. 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].

  10. 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].

  11. Newland CC. Gamekeeper's thumb. Orthop Clin North Am. Jan 1992;23(1):41-8. [Medline].

  12. 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].

  13. 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].

  14. Richard JR. Gamekeeper's thumb: ulnar collateral ligament injury. Am Fam Physician. Apr 1996;53(5):1775-81. [Medline].

  15. 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.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.