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Gamekeeper's Thumb Follow-up

  • Author: Matthew Hannibal, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Mar 20, 2015
 

Return to Play

After surgical repair, the MCP joint is immobilized in a cast for 4 weeks. After this period, the cast is removed and replaced with a removable thumb spica splint so that MCP motion can begin. This is continued for 2 weeks; then the splint is removed completely so the MCP joint can be fully mobilized. Unrestricted usage and return to sports can begin at 3 months.

Patients are not recommended to return to sports that may stress the hand before 3 months have passed. Premature return to full activity can stress the repair or reconstruction and cause chronic joint instability, which is then very difficult to treat. Chronic pain and degeneration can then develop at the MCP joint of the thumb.

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Complications

Chronic instability of the MCP joint can occur despite a good surgical repair, especially if motion and return to play are resumed prematurely. This instability is difficult to treat and can lead to arthritic changes in the MCP joint, as well as weak pinch grasp in the long term.

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Prevention

Currently, there are no proven accessories for the prevention of Gamekeeper's thumb injuries. Ski gloves are being designed to protect the thumbs during skiing, but these have not yet been proven effective.

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Prognosis

Early diagnosis of Gamekeeper's thumb injuries is one of the most important factors that determines functional outcome. In thumbs with partial ligament injuries, nonoperative treatment by immobilization will yield a stable, painless thumb with nearly normal motion in most cases. In thumbs with a complete rupture that are treated operatively within 3 weeks of injury, a good to excellent result can be expected in >90% of cases.

Pain and stiffness in the affected thumb can be expected to be mild or absent, and pinch and grip strength should be nearly normal. The rate of return to former activities, including recreational sports, has been reported as high as 96%.

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Contributor Information and Disclosures
Author

Matthew Hannibal, MD Staff Physician, Carolina Orthopedic Specialists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Acknowledgements

Daniel Roger, MD Director of Hand Surgery, Wyckoff Heights Medical Center; Former Assistant Professor, Department of Orthopedics, Catholic Medical Center of Brooklyn and Queens, New York Medical College

Daniel Roger, MD is a member of the following medical societies: Medical Society of the State of New York

Disclosure: Nothing to disclose.

References
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Lateral radiograph displaying a gamekeeper's fracture.
Anteroposterior radiograph displaying a gamekeeper's fracture.
Radiographic stress test view of the thumb, showing an ulnar collateral ligament tear.
Ulnar collateral ligament stress test in full extension.
Ulnar collateral ligament stress test in a flexed position to isolate the proper portion of the ligament.
Anterior view of a hand placed in a thumb spica splint.
Lateral view of a hand placed in a thumb spica splint.
 
 
 
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