What is "Gamekeepers Thumb"?

Question

I'm just back from the doctors, he sending me to the hospital as he thinks I've got "Gamekeepers Thumb"?

I can only find Skiers Thumb on the Internet.

Answer 1

Same thing in reality:

History of the Procedure: Campbell originally coined the term gamekeeper's thumb in 1955. Gamekeeper's thumb was most commonly associated with Scottish gamekeepers, especially rabbit keepers, in whom it was a work-related injury. The injury occurred as the gamekeepers sacrificed the rabbits by breaking their necks between the ground and their thumbs and index fingers. The thumb would be injured as a result of the valgus force on an abducted metacarpophalangeal (MCP) joint. The ulnar collateral injury would result in instability accompanied by pain and weakness of the pinch grasp.

Today, the injury is typically more acute. The most common mechanism is a skier's landing with his or her hand on a ski pole, causing a valgus force on the thumb. The term skier's thumb reflects the acute nature of the injury.

Problem: Gamekeeper's thumb is clinical instability of the first MCP joint caused by an insufficiency of the ulnar collateral ligament (UCL) in the MCP of the thumb. Because the stability of the thumb is important for prehension, treatment is directed toward optimizing the healing of the ligament to restore its full function.


Frequency: Gamekeeper's thumb is a common injury. The incidence is increased in skiers, but it does not depend on the type of ski pole used. No sex-related proclivity exists.

Etiology: Gamekeeper's thumb is caused by a valgus force directed on the thumb MCP joint to produce a failure of the UCL. Falls on an abducted thumb are common mechanisms. Another common mechanism is the fall of a skier against a planted ski pole.

A Stener lesion occurs when the adductor aponeurosis becomes interposed between the ruptured UCL and its site of insertion at the base of the proximal phalanx. Thus, the distal portion or the ligament retracts and points superficially and proximally. A rupture of the proper and accessory collateral ligaments must occur for this injury to happen. The UCL no longer contacts its area of insertion and cannot heal. This lesion also can be associated with the gamekeeper's fracture, which can be subtle or obvious. However, a lump or mass over the ulnar aspect of the MCP joint of the thumb does not necessarily imply a fracture; it may be the result of the Stener lesion.

Occasionally, failure of the UCL avulses a small portion of the proximal phalanx at its insertion, leading to a gamekeeper's fracture. However, this fracture can involve a substantial portion of the articular surface of the proximal phalanx.

Clinical: The injured thumb should be evaluated for swelling and pain at the ulnar aspect of the MCP joint. Ecchymosis is frequently seen. A palpable mass on the ulnar aspect of the MCP joint may represent the retracted UCL stump that is proximally and dorsally displaced relative to the adductor aponeurosis. The uninjured thumb should be evaluated first to assess its range of motion (ROM) and valgus stability in both extension and 30° flexion.

The range of flexion and extension of the thumb MCP joint varies considerably. The variation of normal joints can include ROMs of 5-115° of flexion and extension. In full extension, valgus laxity averages 6° and increases to an average of 12° in 15° of flexion.

The accessory collateral ligament may remain intact, and gross instability may be absent. The thumb should be placed in 30° flexion and tested for valgus instability in this position. This maneuver should be performed only after the radiographic findings rule out a gamekeeper's fracture.

Although a gamekeeper's fracture is a contraindication to stress testing, a nondisplaced avulsion fracture is not. If the pain is severe, the joint may be anesthetized with a lidocaine injection prior to stress testing. Laxity of 35° or laxity 15° more than that on the uninjured side represents a ruptured proper collateral ligament in this position. A supination deformity of the MCP joint, which may be visualized, can be associated with the volar subluxation of the MCP joint and suggests instability.

A Stener lesion can be present only when both the proper and accessory collateral ligaments are ruptured. In more than 80% of complete ruptures of the UCL, a Stener lesion is present, whether it is palpable or not. Stress testing with the thumb in the extended position is the best test for determining the competence of the accessory collateral portion of the UCL. Again, valgus laxity of more than 35°or laxity 15° more than that on the uninjured side suggests rupture of this portion of the ligament. If valgus laxity of the MCP joint is present in both the flexed and extended positions, complete UCL rupture should be suspected.

Nonsurgical treatment can be considered for partial tears, that is, grade I or grade II tears, of the UCL. These tears usually involve an isolated rupture of the proper collateral ligament.

Complete ruptures of the UCL can be determined by means of physical examination, including stress testing. Radiographic stress testing can be performed, but the evaluating surgeon should perform these tests because stress radiographic findings can be misleading.

In pediatric gamekeeper's thumb, the injury usually involves a Salter-Harris type III fracture of the thumb proximal phalanx. If the fragment is displaced by less than 2 mm, nonsurgical management is indicated. For greater displacement, the fracture should be opened and reduced.

Occasionally, significant ligamentous injury may occur without immediate gross instability, which can be masked by swelling and muscle spasm. At this point, a repeat examination can be performed after 1 week; and if swelling persists and motion has not been regained, surgical fixation may be considered.

Relevant Anatomy: The MCP joint is a diarthrodial joint that is primarily involved in flexion and extension. The static restraints and some dynamic stabilizers provide joint stability. The static restraints include the proper collateral ligament (mostly in flexion), the accessory collateral ligament (mostly in extension), the palmar plate (mostly in extension), and the dorsal capsule (limited, in flexion). The dynamic stabilizers include the thumb intrinsic and extrinsic muscles. The adductor mechanism is particularly important here, because it inserts onto the extensor expansion through its aponeurosis, which lies superficial to the UCL.

The UCL is a 4- to 8- X 12- to 14-mm band that originates from the metacarpal head and inserts into the medial aspect and base of the proximal phalanx of the thumb. Occasionally, when the UCL is strained, it avulses the bone at its insertion and leads to a gamekeeper's fracture.

Contraindications: In this disorder, no absolute contraindications to surgery exist.

Relative contraindications include the following: The patient is too infirm to tolerate surgery, regardless of whether a complete UCL tear is present; gamekeeper's thumb in present in a child, with less than 2 mm of displacement of the Salter-Harris type III fracture; and chronic instability of the thumb due to a chronic UCL rupture is present.

Chronic instability of the thumb due to a chronic UCL rupture is difficult to treat, and repair using the capsuloligamentous structures of the ulnar border of the MCP joint has limited success. Even surgical repair performed 6 weeks after the complete UCL rupture has limited success. Essentially, the longer a complete rupture of the UCL exists, the smaller the possibility of stability restoration with anatomic repair.

Some surgeons have reported success with the dynamic transfer of a tendon such as the adductor pollicis from its insertion onto the ulnar sesamoid to the ulnar base of the proximal phalanx. Others have reported success with the use of static tendon transfers, which have the theoretic advantage of an inherent blood supply if some continuity of the tendon with its musculotendinous unit is preserved. Some surgeons even recommend MP fusion in cases of chronic gamekeeper's thumb; others reserve this procedure for use in those with concomitant osteoarthritis.

Answer 2

Gamekeepers Fracture

Answer 3

Gamekeeper's thumb

An acute radial stress on the thumb metacarpophalangeal joint (Figmay disrupt its ulnar support. Tissue failure is usually rupture of the ulnar collateral ligament from its insertion at the base of the proximal phalanx. Injury can occur in the form of an avulsion fracture, less commonly as a combined fracture and ligament tear, or as a ligament rupture through the central or proximal ligament. The historical eponym refers to the gamekeeper who repeatedly dispatched small animals by using their thumb to push forcefully on the back of the animal's head, breaking its neck. The injury may result in an irreducible displacement of the end of the ligament. For irreducible ligament displacement, the following events must occur: at the time of maximum displacement, the extensor mechanism overlying the ligament tears, allowing the torn ligament end to protrude through a buttonhole, where it becomes trapped in a subcutaneous position . 16). This specific scenario is referred to as the Stener lesion and is important because spontaneous ligament healing is prevented by interposition of the thumb extensor mechanism, requiring surgery to prevent chronic instability. The Stener lesion occurs in a sizable minority of thumb ulnar collateral ligament injuries, and should be suspected when the metacarpophalangeal joint is grossly unstable, or when there is a persistent firm mass on the ulnar aspect of the thumb metacarpal head. In most cases, ligament reinsertion is possible months or even years after injury, and should be considered to stabilize the thumb and prevent early degenerative changes from persistent subluxation.

Answer 4

Injury to the ulnar collateral ligament of the thumb

Answer 5

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