Which of the following is TRUE regarding gamekeeper's thumb?...

Name: Problem 6, Chapter 14: Emergency Medicine Examination & Board Review
Uploaded: 2021-10-24T07:06:02-08:00
Duration: 2 min 19 s
Channel: Qudsiya Anis
Description: Which of the following is TRUE regarding gamekeeper's thumb? (A) The mechanism of injury is usually forced adduction at the MCP joint. (B) Delaying surgery as long as 1 month for an acutely ruptured ligament will help preserve future function. (C) More than 40 degrees of radial angulation on stress testing indicates complete rupture. (D) Injury to the dorsal capsule and volar plate are rare.

Which of the following is TRUE regarding gamekeeper's thumb? (A) The mechanism of injury is usually forced adduction at the MCP joint. (B) Delaying surgery as long as 1 month for an acutely ruptured ligament will help preserve future function. (C) More than 40 degrees of radial angulation on stress testing indicates complete rupture. (D) Injury to the dorsal capsule and volar plate are rare.

Which of the following is TRUE regarding gamekeeper's thumb?
(A) The mechanism of injury is usually forced adduction at the MCP joint.
(B) Delaying surgery as long as 1 month for an acutely ruptured ligament will help preserve future function.
(C) More than 40 degrees of radial angulation on stress testing indicates complete rupture.
(D) Injury to the dorsal capsule and volar plate are rare.

Key Concepts

Ulnar Collateral Ligament (UCL) Injury

This injury involves the tearing or rupture of the ulnar collateral ligament, which is a key stabilizer of the thumb metacarpophalangeal (MCP) joint. Damage to this ligament can lead to instability and decreased function of the thumb, impacting grip and pinch strength.

Mechanism of Injury

In the context of UCL injuries such as gamekeeper's thumb or skier's thumb, the typical mechanism involves a forced abduction or valgus stress at the thumb MCP joint. This stress causes the ligament to stretch or tear, particularly during sudden or repeated loading of the thumb in an abducted position.

Valgus Stress Testing

Valgus stress testing is a clinical maneuver used to evaluate the integrity of the UCL. During this test, a force is applied to the thumb in a direction that stresses the medial (ulnar) side of the joint, allowing physicians to assess the degree of joint instability and differentiate between partial and complete tears.

Radial Angulation on Stress Testing

Radial angulation measured during valgus stress testing is an important diagnostic parameter. When the thumb exhibits more than 40 degrees of deviation under stress, it typically indicates a complete rupture of the UCL, as the excessive displacement suggests that the ligament is not providing the necessary restraint.

Timing of Surgical Intervention

The timing of surgical repair in UCL injuries is critical. Acute complete ruptures are generally managed with timely surgical intervention to restore stability, while delaying surgery may lead to suboptimal healing, chronic instability, and poorer functional outcomes.

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