Gamekeepers thumb: a prospective study of functional bracing

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hand Surgery

Background:

• Acute thumb metacarpophalangeal (MCP) joint injuries require accurate diagnosis and effective treatment.
• Ulnar collateral ligament (UCL) tears, including displaced Stener lesions, present diagnostic challenges.
• Assessing joint instability and tissue damage is crucial for treatment planning.

Purpose of the Study:

• To evaluate the efficacy of a non-invasive treatment regimen for acute MCP joint injuries.
• To assess the diagnostic utility of stress radiography and arthrography in differentiating UCL tears.
• To determine functional and subjective outcomes following conservative management.

Main Methods:

• Patients underwent clinical examination, stress radiography, and arthrography for injury assessment.
• Treatment involved a custom-fit splint and range-of-motion exercises for at least 6 weeks.
• Follow-up was conducted for a minimum of 1 year, with 32 patients available.

Main Results:

• Mean relative joint instability significantly improved from 17 to 2.3 degrees (p=0.0001).
• Over 90% of patients reported good or satisfactory functional and subjective outcomes.
• All patients with Stener lesions had satisfactory outcomes, despite slightly less joint stabilization.

Conclusions:

• Conservative treatment with splinting and exercises is an effective, economical, and non-invasive approach for acute MCP joint injuries.
• Arthrography accurately differentiates displaced (Stener lesion) from undisplaced UCL tears.
• The described treatment regimen yields high success rates, even for complex ligamentous injuries.