skier's thumb

definition

The ski thumb is usually a painful ligament injury. This usually leads to a complete rupture of the lateral ligament (med. Ulnar ligament or ulnar collateral ligament) at the base of the thumb. The tape can break at different positions. Medically one distinguishes three localizations:

  • either in the middle (med. interligamentär)
  • close to the base (this refers to the end of the band in the direction of the wrist)
  • or distal (this is the direction of the thumb).

Partially, the ligament injury can be combined with a bony splintering (med.

Occasionally there is only a sprain with a ligament tear or an elongation.

Synonyms

  • Ligament injury to the metacarpophalangeal joint
  • Rupture of the ulnar collateral ligament
  • Rupture of the ligamentum collaterale ulnare
  • Thumb pain

reason

The cause is often a violent spread (Radialduktion in the thumb Grundgelenk) of the thumb. This can occur as a result of a fall while skiing or through various other sports.

The most common causes include falls during skiing, for example by sticking the thumb in the loop of the ski pole. But impact injuries in ball sports can often lead to this injury.

  • This article may also interest you: Overdrawn thumb

anatomy

The thumb band (ulnar collateral ligament) runs on the thumb inside, so medically on the small finger side of the thumb.
For those with medical interests, the ulnar collateral ligament descends from the dorsoulnar side of the metacarpal-I head and attaches to the base of the basal phalanx on the ulnar side.

The ulnar collateral ligament serves to stabilize the metacarpophalangeal joint and is a prerequisite for fine movements such as holding objects or firm access.

Symptoms and diagnostics

The injury is often felt by a crack in the thumb in the accident or audible. A short time later, both a marked swelling with a bruise (hematoma) and a swelling in the area of ​​the metacarpophalangeal joint appear
In addition, there is a detectable increased in the clinical examination increased Aufklbarkeit (sign of instability) of the thumb metacarpal joint, since a stabilization by the band is missing. In addition, there is a painful limitation of the gripping function.

Due to the pain occurring after the accident, a diagnosis by a clinical examination can not always be guaranteed. Therefore, a re-examination should take place after immobilization.
For this purpose, a side comparison to the movement test is recommended, since there is a large variance in the mobility of the metacarpophalangeal joint. To exclude a bony outbreak, an X-ray of the thumb must be made, if necessary, held photographs for comparison.

After a few days, the symptoms may seem to improve even without treatment. Nevertheless, it is strongly advised to consult a specialist in orthopedics.

If the ski thumb remains untreated, the constant rubbing on the articular cartilage causes wear on the metacarpophalangeal joint (joint arthrosis). The pain that may develop as a result can cause the base of the thumb to stiffen and malpositions that may develop remain.

  • Pain in the thumb base joint .
  • Pain in the thumb saddle joint

Clinical classification

There are four stages for the ski thumb:

  1. Sprain with smaller fiber tears of the band. One speaks also of a distortion
  2. Complete ligament tear (ligament rupture)
  3. Bony ligament tear
  4. Auskugeln (luxation) in the thumb Grundgelenk

complication

In one form of the ski boot, a part of the band remainder may strike against the edge of a tendon plate (tendon aponeurosis of the M. adductor pollicis). This is called the Sterner lesion. With this type of injury, an anatomical healing is no longer possible because the band remains can no longer approach. The consequence is the development of chronic instability.

therapy

In principle, a distinction is made between the therapy for the acute injury and the therapy for chronic instability.
In the case of acute injury, there is the possibility to proceed conservatively or surgically. There are no reliable diagnostic features for deciding which therapy option to choose. In general, with a slightly flexed joint, a fold-out of 35 ° is considered an indication for surgery.
From the clinical experience, hardly a Skischaumen must be treated surgically.

If one chooses the conservative approach, the thumb is immobilized in a thumb forearm plaster for 3 weeks. After 3 weeks you start with careful mobilization. After two more weeks you steadily increase the load. After 10-12 weeks, the full resilience of the thumb should be restored. Alternatively, the injury may also be restrained in a tape bandage or a thumb splint.
The thumb splint is in most cases Nicolas Gumpert favored method of therapy.

If the indication for the operation is made depending on the type of tear different methods to choose from. On the one hand, the band ends can be sewn, but also a supply via a special wire seam is possible. If there is a bony tear, it will be refixed with special wires.

After surgery, the thumb is immobilized for 6 weeks. After this time, the physiotherapeutic exercise treatment begins to restore normal joint function.

If there is a chronic instability, usually a plastic band is performed. This often involves the Palmaris longus tendon. If there is still an instability in the joint or if post-traumatic osteoarthritis develops (osteoarthritis as an accident), the thumb-joint is stiffened because stability is crucial for the good function of the joint.

forecast

If the band is exactly adapted and sewn or after the injury directly and consistently the ski thumb has a good prognosis.

In the plastic band may be restricted in mobility or the instability may persist.


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