Name:
Gamekeeper's/Skier's Thumb and Ulnar Collateral Ligament Examination
Description:
Gamekeeper's/Skier's Thumb and Ulnar Collateral Ligament Examination
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/486b948d-f258-4914-b2b9-2610df021bea
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/486b948d-f258-4914-b2b9-2610df021bea/Gamekeeper%27s _Skier%27s Thumb and Ulnar Collateral Ligament Ex.mp4?sv=2019-02-02&sr=c&sig=DgoyrSPCmBPp7WjunZz5kgbHPomdZ14r9TglYI3sVdU%3D&st=2025-04-27T17%3A10%3A32Z&se=2025-04-27T19%3A15%3A32Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello,viewers. Today we are going to talk about gamekeeper's thumb or skier's thumb. It is a very common injury that happens to the joint of your thumb. So there are two ligaments. One is the inside ligament and one is the outside ligament. So we're talking about ligament, which is inside, which is called ulnar collateral ligament injury.
And I'm also going to show you a test as how to assess this joint if somebody has injury to this ligament. So the most common way this injury happens is, as you say, in a ski injury in which there is hyper abduction. So the thumb is forced outwards or a combination of extension and abduction, which causes increased strain over the ligament, that is ulnar collateral ligament and then it ruptures.
So in terms of anatomy, we should be aware about three important structures. One is the proper ulnar collateral ligament. One is the accessory collateral ligament, and other is the volar plate. So if you see this diagram, this is proper ulnar collateral ligament, which goes at a slightly slight inclination, roughly around 40 degrees, which starts from metacarpal head and goes on to the base of the phalanx.
The accessory collateral ligament is more fan shaped and goes more vertically and this structure down is the volar plate. So I have drawn the same three structures on this patient's hand. This is the normal side. So this is proper ulnar collateral ligament. This is extra sensory collateral ligament. and this is the volar plate.
Now, this proper ulnar collateral ligament is responsible for stability when thumb is slightly bent. So you bend the thumb to around 30 degrees of flexion, and that is when it resists the valgus force. When your thumb is flexed, you are assessing proper ulnar collateral ligament. Same metacarpophalangeal joint in extension when you do a valgur stress, then the structures which is responsible for the instability is exerted collateral ligament and volar plate.
So extra sensory accessory collateral ligament and volar plate are responsible for stability of carpometacarpal phallangeal joint in extension and proper ulnar collateral ligament in 30 degree of flexion. So whenever somebody has got injury, always examine the normal side so that you have a comparison when you examine the abnormal side. So this is now the left hand of the same patient, he fell from the motorcycle
and he doesn't remember actually what happened, but now he's complaining of a lot of pain. So first thing you notice, there's a lot of swelling on the inside. So that is first sign that will give you an indication that this ligament may be injured. If you look at the outside, the radial collateral ligament, this is very uncommonly injured and looks pretty normal.
So first, we are going to examine this joint in extension. So when I examine an extension, if you remember from the other side, this is opening up much more than what it was on the normal hand. So if I show you the normal hand again, in extension, it's opening just maybe around 15, 20 degrees, here it's opening a lot.
So that means that accessory, collateral ligament plus minus volar plate is injured. Now, I'm going to examine the same joint, we are going to bend it around 30 degrees so if you see here, I've just bended around 30 degrees and if you see, it's opening a lot. So this is a clear indication that in this patient there is damage to both accessory as well as proper ulnar collateral ligament.
So most of these injuries are treated non surgically. That means we give thumbs spica for roughly around four weeks and we start mobilizing the hand. However, if there is a bony fragment which is displaced or there is mark opening of the joint suggestive of in a complete rupture, then they may be associated with stena lesion. So stena lesion happens when the aponeurosis gets interposed between two ends of the ulnar collateral ligament.
And because there is a degree of neurosis between two ends, there is not proper healing. That is that may be one indication where you have to operate and you may have to repair and use suture anchors. So friends, this was the video where I told you a little bit about gamekeeper's thumb and I also showed you how to examine ulnar collateral ligament properly.
I hope you like this video. Do subscribe to our channel and do share this video.
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