1. Andrew Traber Jaime Miller

2. Radiographs

3. What is gamekeepers thumb?  It’s a sprain to the thumb’s ulnar collateral ligament  This use to occur when gamekeepers broke the neck’s of rabbits by using the thumb and index finger against the ground

4. Mechanism of Injury  Falling on an outstretched hand  Valgus force on the thumb while the thumb is abducted  Generalized ligamentous laxity

5. Signs and Symptoms  Pain and inflammation at the ulnar site of the MCP joint  Ecchymosis  Loss of ROM compared bilaterally  Unstable joint  Inability to pinch

6. Therapeutic Modalities  Ice cup massage to decrease pain and inflammation  Paraffin bath used to increase blood flow to the area  Ultra Sound to decrease pain and edema assuming there is no avulsion fx.

7. Stener Lesion  Distal attachment of the UCL is avulsed from the proximal phalanx of the thumb  The avulsed part then gets trapped under the adductor apponeurosis

8. Lifestyle:  22 year old male collegiate football offensive lineman  Plays about six times a week for about two hours a each day  Has PH of thumb problems in the past

9. Surgical Technique  Incision is made on the mid-lateral aspect of the ulnar side of thumb  The incision curves over the MP joint and extends proximal to the to the extensor pollicus longus tendon.  The adductor aponeurosis is identified and then detached from the EPL.  The adductor aponeurosis is then left alone until it’s time to close the wound

10. Surgical Technique  After the add. Aponeurosis is detached the UCL is now visible.  If the tear is unable to hold a suture a pull out wire technique is then used.  If the ligament is torn at the midpoint sutures are placed with the MCP joint flexed at 15 to 20 degrees of flexion

11. Surgical Technique  For chronic instability: A reconstruction is done by using a slip of the APL tendon. The tendon graft is fed through holes and secured above the joint.

12. Postoperative Management/Rehabilitation  For the first 3-4 weeks the patient is put in a short arm thumb spica cast.  The cast then can be removed and the pt is put in a thumb spica splint.  Patient is advised to only take the splint off for hygiene and for rehab for the next 2 weeks.

13. Postoperative Management and Rehabilitation  The first 4 weeks of rehabilitation will just be ROM and strengthening of the IP and MCP joints of the other 2 nd -5 th Digits.  We will also be working on core strengthening and cardiovascular conditioning with our athlete while he is still in the cast

14. Postoperative Prevention

15. Flex-a-Grip