Medication Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs), which decrease pain and swelling, are the drugs of choice (DOC) in the acute phase of a gamekeeper's thumb injury. The anti-inflammatory effects decrease the acute swelling that is associated with this condition, allowing for a better examination at follow-up (if necessary).
NSAIDs are nonopioid analgesics that are made up of different compounds but classed together based solely on their clinical effects. They typically work by inhibiting the formation of prostaglandins through the cyclooxygenase pathway. NSAIDs do not promote dependence like the opioid agents, but they can be associated with renal, liver, and gastrointestinal (GI) toxicities.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Class Summary
Pain control and anti-inflammatory effects are essential to the quality of patient care. They are beneficial to patients who have a painful injury.
Ibuprofen (Ibuprin, Advil, Motrin)
DOC for mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Anaprox, Naprelan, Naprosyn)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Cyclooxygenase-2 (COX-2) inhibitors
Class Summary
Although increased cost can be a negative factor in the use of COX-2 inhibitors, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of the cost avoidance of GI bleeds will further define the populations that will find these agents the most beneficial.
Celecoxib (Celebrex)
Celecoxib inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, the COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.
-
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.
