Thumb ulnar collateral ligament tear
What is it?
An ulnar collateral ligament tear (UCL) of the thumb is an injury to the ligament that stabilizes the inside of the thumb metacarpophalangeal (MCP) joint.
What causes it:
Sticking out alone from the hand, the thumb is naturally vulnerable to injury. Acute injuries such as falls may direct forces into the first webspace that separate the thumb from the rest of the hand, resulting in injury to the ligament. The injury has earned the nickname Skier’s Thumb due to the frequency it is encountered among skiers who fall with a ski pole in their hand. Ligament tears can also occur by the accumulation of smaller injuries over time.
What are the symptoms?
Pain and instability of the thumb MCP joint when trying to pinch are the symptoms encountered after injury.
How is it diagnosed?
A physical exam can determine whether an injury is present and the degree of instability present by comparing the laxity at the thumb MCP joint to the other side. Xrays may reveal an associated fracture. An MRI may be used in indeterminate cases or to further evaluate whether an injury contains a Stener lesion. A Stener lesion occurs when the torn ligament is displaced and retracts behind a band of tissue called the adductor aponeurosis, preventing normal healing of the ligament.
How is it treated?
Partial injuries and even complete injuries with fractures can be treated conservatively with immobilization in a cast. If a Stener lesion is present or if the patient desires a more prompt return to function, surgery can repair the ligament. Typically an incision is made over the inside of the thumb MCP joint and the ligament is repaired with suture tied to anchor. A repair can also be reinforced with strong suture than can accelerate the rehabiliation from the injury by protecting the repair. If the injury is chronic in nature and insufficient tissue exists for repair, the ligament can be reconstructed with use of a tendon graft.
Therapy for range of motion may be needed after surgery. Depending on the nature of the repair a period of immobilization in a splint or cast may be necessary. Return to sports may be possible from several weeks to several months.
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