Skier's thumb: a literature review

Pseudo-Stener lesion due to proximal ulnar collateral ligament rupture: A case report

INTRODUCTION AND IMPORTANCE

Ulnar collateral ligament (UCL) ruptures are a common injury of the thumb. The UCL will most commonly rupture at the distal insertion. It has been proposed that a partial or non-displaced tear can be managed non operatively. However, a complete rupture that occurs at the distal insertion will commonly not be able to heal non-operatively due to the interposition of the adductor aponeurosis. This clinical finding is known as a Stener lesion, first described by Bertil Stener in 1962.

CASE PRESENTATION

We present the case of a 63-year-old-woman with instability of the thumb, pain, and a small mass at the ulnar side of the metacarpal phalangeal joint (MCPJ).

CLINICAL DISCUSSION

A Stener lesion mass is commonly palpated on the ulnar MCPJ due to the ligament being trapped proximally to the overlying aponeurosis. Our patient mistakenly presented with a Stener lesion that was intraoperatively discovered to be a mass of granulation tissue. This patient underwent repair of the UCL and was able to return to unrestricted daily activities after six weeks.

CONCLUSION

This case highlights an unusual rupture pattern and shows the proper surgical techniques for repairing such an injury. It is imperative to restore joint stability to prevent decreased grip strength and early onset of osteoarthritis of the MCPJ.

LEVEL OF EVIDENCE

Therapeutic Level 3B.

Case Report: Oblique Fracture of the Ulnar Sesamoid Bone of the Metacarpophalangeal Joint, a Rare Pathology

Introduction:

Fractures of the sesamoid bones of the metacarpophalangeal joint (MCPJ) are a rare pathology in hand trauma. Only a few case reports and case series were found in literature. The diagnosis of an ulnar sesamoid bone fracture of the MCPJ is difficult and can pose a differential diagnostic problem with Stener lesions or ulnar collateral ligament (UCL) instability. This pathology is frequently missed with subsequent poor functional outcomes. Correct and early diagnosis is important as this will allow for correct treatment with full recovery of function without sequelae.

Case Presentation:

We report a case of a 35-year-old male Caucasian patient after a thumb injury due to a fall with his mountain bike. X-ray showed a fracture of the ulnar sesamoid of the MCPJ of the pollex, which is rarely reported in this literature. Anamnesis, clinical examination, and X-ray evaluation contributed to our diagnosis. The ulnar sesamoid bone fracture of the MCPJ of the right pollex was initially treated conservatively with immobilization, rest and ice application. After 3-4 weeks, physiotherapy with thenar muscles exercises was started. 10 weeks after the injury, our patient reported a total recovery of function and pain-free thumb movement during daily activities.

Conclusion:

Ulnar sesamoid fractures are rarely reported in current literature. This type of injury should be recognized as early as possible since it can be easily missed. Then a benign course can be expected after short immobilization of the MCPJ of the thumb during circa 2 weeks. UCL instability or a Stener lesion should be excluded at the emergency department by performing an ultrasound. With this case report, we underline the importance of early diagnosis and exclusion of an unstable Stener lesion.

Gamekeeper’s thumb

Gamekeeper’s thumb is a condition resulting from low-grade repeated force through the ulnar collateral ligament of the thumb metacarpophalangeal joint. In its acute form, it is sometimes known as Skier’s thumb and can be associated with tears, ruptures and fractures. Prompt assessment of the thumb’s structural integrity is therefore important in preventing long-term morbidity of metacarpophalangeal joint instability. Diagnosis is usually made clinically, although radiological imaging can act as a helpful adjunct. Unstable injuries tend to have a better functional outcome if repaired surgically. This article will outline relevant clinical anatomy, injury mechanism, clinical assessment and management of ulnar collateral injuries including Gamekeeper’s thumb.

Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes

The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base.

LEVEL OF EVIDENCE

Level IV.