Gamekeeper thumb

Discussion:

Background

The ulnar collateral ligament (UCL) of the thumb MCP joint is the most frequently injured collateral ligament in the hand. The mechanism of injury is caused by valgus stress across the thumb, often combined with hyperextenion.

Management

Most UCL sprains, partial tears and minimally displaced complete tears (as in our case) or avulsions, are managed by immobilization. Complete tears often required surgical exploration to locate and reattach the free edges of the torn ulnar collateral ligament.

Complications

The adductor tendon aponeurosis of the thumb can become interposed between the torn edges of the ulnar collateral ligament, a condition termed the Stener lesion. MRI can aid in identifying the position of the ligament. As the displaced ligament will not heal appropriately, Stener lesions are surgically corrected with anatomic reattachment of the displaced ligament.

Special thanks to Dr. Tamer El Holiby

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