Arthrographic evaluation of injuries of the first metacarpophalangeal joint: gamekeeper's thumb

The radiographic evaluation of gamekeeper's thumb is described in an experimental study in nine cadaveric hands. After the application of radial stress at the metacarpophalangeal joint in the extended and abducted thumbs in an attempt to create defects in the ulnar collateral ligament, initial and stress radiography and arthrography were employed. In four cadavers a fracture of the proximal phalanx was noted; stress radiography revealed variability in joint stability. Arthrography outlined ulnar extravasation in six of the nine cadavers; surgical confirmation of a capsular tear was obtained following careful dissection in each of these six cadavers. It would appear that plain films, stress radiography, and arthrography complement each other in the diagnosis of gamekeeper's thumb.