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  • Thumb ulnar collateral ligament (UCL) tear
  • Thumb UCL sprain
  • Skier’s thumb
  • Breakdancer’s thumb

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  • 842.12 Sprains and strains of metacarpophalangeal (joint) of hand

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  • S63.659 A Sprain of metacarpophalangeal joint of unspecified finger, initial encounter
  • S63.649 A Sprain of metacarpophalangeal joint of unspecified thumb, initial encounter

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Description

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Essentials of Diagnosis

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  • Gamekeeper’s thumb is ligamentous disruption of the UCL of the first MCP joint due to acute or repeated valgus stress to the thumb.
  • Presents as instability and/or pain with valgus forces to the thumb or pain and weakness with opposition or pinching.
  • Tenderness or swelling may be present at medial aspect of thumb.
  • Valgus stress to the UCL of the first MCP will result in asymmetric laxity compared to uninvolved side or lack of an end point.

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General Considerations

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  • Injury can be either acute or chronic and is common in athletics (especially skiing and football).
  • Injury involves valgus force to the proximal phalanx of the thumb.
  • Injury can also involve an avulsion fracture of the base of the proximal phalanx, which is termed “gamekeeper’s fracture.”
  • Plain film radiographs are beneficial to rule out fracture.
  • Manage surgically or non-surgically depending upon severity of signs and symptoms and orthopedic physician recommendations

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Demographics

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  • Common in athletes, typically involving a fall (football), impact from a ball (basketball), or repeated stress (skiing)
  • Seen in fowl hunters

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Signs and Symptoms

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  • Pain over medial MCP joint
  • Palpable tenderness and possible swelling over medial MCP joint line/UCL of thumb
  • Instability and/or pain with valgus stress to MCP of thumb
  • Weakness with pinching or opposition
  • Repeat subluxation of the MCP resulting in medial angulation of the proximal phalanx with valgus stress or force

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Functional Limitations

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  • Difficulty and/or pain when grasping dishes, utensils, or drinking cups due to pain and weakness
  • Difficulty and/or pain when grasping and turning steering wheel
  • Difficulty and/or pain when turning doorknob

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Possible Contributing Causes

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  • Participation in activities or sporting events that involve repeated valgus stress to proximal phalanx in thumb
  • Participation in contact sports
  • Generalized ligamentous laxity

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Differential Diagnosis

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  • Gamekeeper’s fracture
  • Fracture of the base of the first metacarpal bone (Bennett’s fracture)
  • Distal metacarpal fracture
  • Proximal phalanx fracture
  • Extensor tendon rupture (boutonnière deformity)

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Laboratory Tests

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  • Valgus stress test to the proximal ...

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