gamekeeper's thumb

1. Dr. Santosh Batajoo
Resident (Orthopaedic Surgery)

2.  Injury to the metacarpophalangeal joint ulnar
collateral ligament of the thumb.
 A tear or avulsion of the ligament
may occur at the site of insertion
into the phalanx of the thumb.
 Skier’s thumb- acute condition
 Gamekeeper’s thumb – chronic condition – as a
result of repeated episodes.

3.  C S Campbell, an orthopedic surgeon originally
coined the term gamekeeper’s thumb in 1955, after
he observed this condition in a series of Scottish
gamekeepers.

4.  Gamekeeper’s – who kill small animals by
forcefully extending the neck.
 Skiers- who fall onto the extended thumb,
hyperabduction.
 athletes

5.  The capsule is thickened medially and laterally to form
the ulnar and radial collateral ligaments which are static
stabilizer of MCP joint.
 Ligament- proper and accessory
ulnar collateral ligament
 The capsule is thin over its
dorsolateral aspect between EPB and abductor pollicis.
dorsomedial aspect between the EPB and the adductor
pollicis.

6.  Rupture of ulnar collateral ligament caused by
forcible abduction.
 Fall onto an outstretched hand.
 Gamekeeper’s fracture – an avulsion fracture

7. A. Partial rupture – only the ligament proper is torn.
Thumb is unstable in flexion.
B. Complete rupture – Thumb is unstable in all the
positions.

8. The stener lesion – Interposition of the adductor
pollicis aponeurosis between the ends of the torn
ligament.
 Prevent healing of the ligament.
 Chronic instability.
 Present in about 80% of complete
ruptures.

9. type injury treatment
1
2
3
4
5
6
Fracture undisplaced
Fracture displaced
Ligamentous tear, stable
Ligamentous tear,
unstable
Volar lip fracture
Ulnovolar fracture and
ligamentous tear.
Conservative
Surgical
Conservative
Surgical
Conservative
surgical

10.  Swelling and tenderness over the ulnar side of the
thumb metacarpophalangeal joint.
 Bruise like discoloration around the joint.
 Interference in pinching activity, grasp.
 Laxity of the joint
 Lump (stener lesion).

11.  Abduction stress testing
Joint in full extension and 30 degrees of flexion.
Should be compared with the uninjured thumb.
 Stress test in extension with abduction more than 40
degree indicates a complete injury. Compared to
other side- difference of more than 15 degree.

12.  X-ray – To exclude a fracture.
avulsion fracture: fragment from
the base of the proximal phalanx.
Subluxation
Stress view examination
 Minimally displaced (<2mm)
avulsion fracture – complete
avulsion without Stener lesion.
 Ultrasonography
 MRI

13.  Chronic instability
 Arthritic changes in the MCP joint.
 Weak pinch grasp.
 Stiffness of the MCP and IP joints.
 Neurapraxia of the radial sensory nerve.

14.  Partial tear-
Immobilization in a splint for 4-6 weeks followed by
movement.
Thumb spica cast or brace.
 Complete tear-
Operative repair. Immobilized postoperatively for 6
weeks. Flexion extension can be started early.
Interphalangeal joint should be left free.
Unrestricted usage is allowed at 3 months.

15.  Delayed diagnosis – dissecting out the ligament
from within the fibrotic mass and reattaching it.
 Late diagnosed complete tear (several months) -
Repair of the capsulo-ligamentous complex with a
palmaris longus free tendon graft or
MP joint fusion.
 If arthritis is present, arthrodesis of the MCP joint.

16.  Early diagnosis is the important determinant of
functional outcome.
 Complete ruptures that are surgically treated within 3
weeks have good result.
 The prognosis for repairs undertaken longer than 6
weeks is poor.
 Physical therapy after surgery.