Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Thumb ulnar collateral ligament (UCL) tearThumb UCL sprainSkier’s thumbBreakdancer’s thumb ++ 842.12 Sprains and strains of metacarpophalangeal (joint) of hand ++ S63.659 A Sprain of metacarpophalangeal joint of unspecified finger, initial encounterS63.649 A Sprain of metacarpophalangeal joint of unspecified thumb, initial encounter ++ 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Connective Tissue Dysfunction1 +++ Description ++ Injury involving the UCL of the metacarpophalangeal (MCP) joint in the first ray (thumb) Acute or repeated forceful abduction (valgus force) to the proximal phalanx results in ligamentous disruption.Instability of the MCP jointForced extension or abduction of the proximal phalanx of the thumb +++ Essentials of Diagnosis ++ 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. +++ General Considerations ++ 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 +++ Demographics ++ Common in athletes, typically involving a fall (football), impact from a ball (basketball), or repeated stress (skiing)Seen in fowl hunters +++ Signs and Symptoms ++ Pain over medial MCP jointPalpable tenderness and possible swelling over medial MCP joint line/UCL of thumbInstability and/or pain with valgus stress to MCP of thumbWeakness with pinching or oppositionRepeat subluxation of the MCP resulting in medial angulation of the proximal phalanx with valgus stress or force +++ Functional Limitations ++ Difficulty and/or pain when grasping dishes, utensils, or drinking cups due to pain and weaknessDifficulty and/or pain when grasping and turning steering wheelDifficulty and/or pain when turning doorknob +++ Possible Contributing Causes ++ Participation in activities or sporting events that involve repeated valgus stress to proximal phalanx in thumbParticipation in contact sportsGeneralized ligamentous laxity +++ Differential Diagnosis ++ Gamekeeper’s fractureFracture of the base of the first metacarpal bone (Bennett’s fracture)Distal metacarpal fractureProximal phalanx fractureExtensor tendon rupture (boutonnière deformity) +++ Laboratory Tests ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.