Gamekeepers thumb: a prospective study of functional bracing

Patients with acute thumb metacarpophalangeal joint injuries were assessed by stress radiography, arthrography, and clinical examination. Arthrograms served to assess tissue injury by the extent and location of dye leaks including the differentiation of displaced (Stener lesion) from undisplaced tears of the ulnar collateral ligament. Patients were treated for a minimum of 6 weeks by use of a removable custom-fit splint and daily range of motion exercises, and followed at a minimum of 1 year. In the 32 patients available for follow-up, mean relative instability improved from 17 degrees (after injury) to 2.3 degrees (follow-up) (p = 0.0001). Functional and subjective outcomes were good or satisfactory in more than 90% of patients; outcomes for all patients with Stener lesions were satisfactory, although joint stabilization was less than in the whole group. The three failures involved persistent symptoms, that defied subsequent surgery. These cases could not be predicted from the initial clinical tests. The treatment regimen was an economical, noninvasive, and effective method for a range of acute thumb metacarpophalangeal joint injuries.