Thumb Ligament Injuries (Skier's Thumb)
The ulnar collateral ligament (UCL) is a crucial ligament that stabilises the inner side of the thumb's metacarpophalangeal (MCP) joint. It helps maintain the joint's integrity and enables the thumb's fine and powerful pinching movements. Thumb UCL injuries, commonly known as skier's thumb, occur when the UCL at the base of the thumb becomes damaged or torn. Understanding the causes, symptoms, and treatment options for thumb ligament injuries is essential for the proper management of this condition.
Causes of pathology
Thumb UCL injuries can be caused by various factors, including:
- Acute trauma: A forceful impact or sudden hyperextension of the thumb, such as during a fall or while gripping an object tightly, can cause UCL damage or rupture.
- Sports involvement: Activities that involve gripping or holding objects, such as skiing, snowboarding, or contact sports, increase the risk of thumb UCL injuries.
- Repetitive stress: Repeated stress or overuse of the thumb joint, such as in certain occupations or activities, can contribute to UCL damage over time.
Symptoms
The symptoms of thumb UCL injuries may include:
- Pain: Sharp or localised pain at the base of the thumb, particularly during thumb movement or when gripping objects.
- Swelling and bruising: Swelling and bruising around the base of the thumb due to inflammation and bleeding into the tissues.
- Instability: The thumb may feel unstable or loose, with a diminished ability to grip or hold objects securely.
- Limited range of motion: Difficulty fully flexing or extending the thumb, which can affect daily activities.
Types of injury
Thumb UCL injuries can vary in severity, and they can be classified into different types:
Sprain: Partial tearing or stretching of the UCL without complete rupture.
Complete tear: Total rupture of the UCL, resulting in joint instability and loss of function.
Complete tear with Stener lesion: This variant occurs when the ligament ruptures and then gets caught, flipped out of position, and rests on an adjacent tendon. This tendon blocks the ligament from reattaching back onto the bone and has a high rate of causing long-standing issues without surgery.
Treatment options
Non-operative treatment
Non-operative treatment options may be considered for mild to moderate thumb UCL injuries, especially if the tear is not severe or if the patient's lifestyle and demands do not require surgical intervention.
Non-operative treatment typically include:
Immobilisation: Wearing a thumb splint or cast to immobilise the thumb joint and promote healing.
Ice and medication: Applying ice packs and taking over-the-counter pain relievers to reduce swelling and manage pain.
Activity modification: Avoiding activities that stress the injured thumb to prevent further damage.
Physical therapy: Once the acute phase has passed, a physical therapy program may be recommended to strengthen the surrounding muscles and restore thumb function.
Operative treatment
Surgical intervention is often recommended for severe thumb UCL injuries, complete tears, or cases where non-operative treatment has not provided satisfactory results. The surgical options may include:
UCL repair: The torn UCL is repaired using sutures or anchors to reattach the ligament to its proper anatomical position.
UCL reconstruction: In cases where the UCL is severely damaged or insufficient, a graft may be used to reconstruct the ligament.
Following surgery, a structured rehabilitation program is essential to regain thumb strength, range of motion, and stability. Physical therapy exercises are prescribed to optimise recovery.
It is important to consult with Dr Oscar Brumby-Rendell to determine the most appropriate treatment approach based on individual factors, the severity of the injury, and patient goals. Early diagnosis and timely intervention are crucial for successful outcomes and restoration of thumb function.
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