SKI-POLE (GAMEKEEPER'S) THUMB

Question 1

Mechanism

Answer 1

Fall with forced abduction of the thumb
-> Ulnar collateral lig injury 1st MCP

Often injury to the dorsal capsule and volar plate

Tear usually the insertion into proximal phalanx

Question 2

Physical Exam

Answer 2

Stress test the ulnar collateral ligament:
Test thumb MCP in full extension and 30 degree flexion
by stabilizing the metacarpal and applying lateral stress
Gross instability with valgus stressing of 1st MCP
Assess for 2nd vs. 3rd degree tear with local anesthetic

Question 3

Signs of a complete tear

Answer 3

Pain
Ecchymosis of the thumb MCP
Weakness of pinch

More than 30 degrees of radial angulation
OR
10 to 15 degrees more than the contralateral thumb

Question 4

X-RAY

Answer 4

2V Thumb
r/o avulsion fracture

Question 5

Management: Grade 1-2

Answer 5

Thumb spica splint
4-6 weeks
Follow up with hand in 1-2 weeks

Question 6

Management: Grade 3

Answer 6

Operative within 1 week of the injury