Gamekeeper's Thumb Follow-up

  • Author: Matthew Hannibal, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 17, 2010
 

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.

Coauthor(s)

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.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

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

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

  3. Bekler H, Gokce A, Beyzadeoglu T. Avulsion fractures from the base of phalanges of the fingers. Tech Hand Up Extrem Surg. Sep 2006;10(3):157-61. [Medline].

  4. Malik AK, Morris T, Chou D, Sorene E, Taylor E. Clinical testing of ulnar collateral ligament injuries of the thumb. J Hand Surg Eur Vol. Jun 2009;34(3):363-6. [Medline].

  5. Heyman P. Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. Jul 1997;5(4):224-9. [Medline].

  6. Baskies MA, Tuckman D, Paksima N, Posner MA. A new technique for reconstruction of the ulnar collateral ligament of the thumb. Am J Sports Med. Aug 2007;35(8):1321-5. [Medline].

  7. Shinohara T, Horii E, Majima M, et al. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound. Feb 2007;35(2):73-7. [Medline].

  8. 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].

  9. 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].

  10. Sollerman C, Abrahamsson SO, Lundborg G, Adalbert K. Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases. Acta Orthop Scand. Dec 1991;62(6):524-6. [Medline].

  11. Maheshwari R, Sharma H, Duncan RD. Metacarpophalangeal joint dislocation of the thumb in children. J Bone Joint Surg Br. Feb 2007;89(2):227-9. [Medline].

  12. Abrahamsson SO, Sollerman C, Lundborg G, Larsson J, Egund N. Diagnosis of displaced ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. May 1990;15(3):457-60. [Medline].

  13. Gerber C, Senn E, Matter P. Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint. Am J Sports Med. May-Jun 1981;9(3):171-7. [Medline].

  14. Michaud EJ, Flinn S, Seitz WH Jr. Treatment of grade III thumb metacarpophalangeal ulnar collateral ligament injuries with early controlled motion using a hinged splint. J Hand Ther. Jan-Mar 2010;23(1):77-82. [Medline].

  15. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. Mar 2010;20(2):106-12. [Medline].

  16. Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg [Br]. July 1962;44:869-79. [Full Text].

 
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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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