| > Site Map |
| Tendon
& Ligament Injuries > Ulnar Collateral Ligament Tear of the
Thumb (Skier's Thumb) What is Ulnar Collateral Ligament Tear? Ligaments are bands of tough, fibrous tissue connecting two or more bones or cartilages, and they support muscles, fascia, and organs. The ulnar collateral ligament of the thumb is the main stabilizer of the metacarpophalangeal (MP) joint of the thumb, meaning it keeps the thumb from going the wrong direction. When this ligament is torn, the thumb becomes unstable, deviating outward (radially) when attempting to pinch with the index finger. This injury happens to many skiers who fall one way while their thumbs get yanked by the ski pole that is stuck in the snow. Perhaps one of the first work-related diseases, ulnar collateral ligament tear was once known as "gamekeeper's thumb." Early European gamekeepers used to kill game by grabbing it by the neck between the thumb and the index finger. The ulnar collateral ligament would eventually stretch, leaving gamekeepers with chronically unstable thumbs. Causes of Ulnar Collateral Ligament Tear? The most common mechanism of injury today is an accident with a ski pole, giving this condition the new eponym "skier's thumb." Very often the thumb is forced outward at the MP joint from the strap on a ski pole or from the pole itself during a skiing accident. When this happens, patients almost always recall the instant of injury. Ulnar collateral ligament tear represents the major upper limb injury (60 percent) experienced by skiers. It can also be the result of an accident during basketball, football, or some other situation in which the thumb is abruptly pushed outward from the joint. Unfortunately, it is often overlooked and underdiagnosed. If left untreated it will most likely result in a long-term disabling condition. Symptoms of Ulnar Collateral Ligament Tear? If you have experienced an ulnar collateral ligament tear, you will have difficulty pinching and grasping. Because of the instability of the thumb, you will find it difficult to catch a ball or grip a racquet. There will be pain and swelling around the MP joint, which may be discolored and will probably also be tender to the touch. Treatment of Ulnar Collateral Ligament Tear? If you have suffered an injury of the hand, use ice to limit swelling and seek medical care immediately. Many tissues quickly lose their elasticity and maximum healing depends on prompt treatment. Your doctor will examine the hand and palpitate the site for tenderness and swelling. He or she will ask about your medical history and other conditions of the hand, wrist, and arm. Details concerning the accident causing the injury sometimes provide diagnostic clues. Your doctor is likely to order x-rays to rule out the possibility of a fracture or dislocation. Occasionally there is a fracture of the base of the proximal phalanx, the lowest bone of the thumb. Stress test x-rays of the MP joint help determine if the tear is complete. Local anesthetic is usually used before this test, both to ensure patient comfort and to allow for better characterization of the degree of laxity in the joint. Sometimes x-rays of the uninjured thumb are taken for comparative purposes. Nonoperative management is occasionally effective. If the tear is incomplete and likely to heal without surgical intervention, your doctor will stabilize the thumb with a spica cast. After 3 or 4 weeks of rest and immobilization, you will be advised to initiate specific flexion and extension exercises. The thumb is taken out of the cast during exercise, but the protection of the cast should continue at all other times for an additional 2 to 3 weeks, or until tenderness and swelling have completely subsided. The risk of opting for nonoperative repair is that it may be ineffective in the long-term, resulting in posttraumatic pain and the onset of arthritis in the MP joint. Like other common musculoskeletal injuries, early treatment is the key to full recovery. Results of early surgical repair (within two or three weeks of injury) are typically superior to those of later corrections. Surgery for this condition can usually be performed on an outpatient basis, using an axillary block or general anesthesia. The ruptured ligament tends to fold in upon itself, so the surgeon repositions and repairs it, reattaching it to its site of origin. Surgical risk increases with smoking and/or the use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids. Drink only water before manipulation or surgery. After surgery the thumb and wrist are initially protected with a compressive bandage, followed by a spica cast when sutures are removed. This cast is usually worn for 6 weeks. Follow your doctor's instructions carefully. He or she may recommend that you regularly apply localized heat to the injury through the cast using a heat lamp or heating pad. Heat promotes healing by increasing the flow of blood to the injury. Your doctor will show you how to exercise all muscle groups that are not immobilized. Muscle contractions in these parts of the hand and arm aid the healing process. Eat a well-balanced diet that includes extra protein such as meat, fish, poultry, cheese, milk, legumes, tofu, and eggs. After the cast is removed therapy may continue to include the application of localized heat, hot baths, or whirlpool treatments. You may be advised to use ice massage for ten minutes before and after conditioning the hand. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top of the cup so the ice protrudes, and massage firmly over the injured area using circular motion. Do this for 15 minutes at a time, 3 or 4 times a day. Everyone recovers from injury at a different rate, and return to normal activities must be determined on the basis of how well your thumb and wrist have recovered, not on the length of time that has passed since the injury occurred. The goal of treatment is to develop strength in the injured hand, wrist, and forearm that is as close as possible to that of the uninjured side. There should not be any pain when gripping or doing such things as swinging a racquet. Be aware of pain and tenderness in the thumb, reporting any discomfort to your doctor. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. ©2000 DynoMed.com, LLC, Indianapolis, IN |