- Avulsion of the ulnar collateral ligament of the base of the thumb
- Usually results from sudden hyper-abduction/extension injury to the thumb either from a fall or tackle situation, when wrapped around a ski pole.
- Pain is felt on the inside/ulna side of the base of the thumb. There is weakness with pinch grip
- Examination shows an opening up of the joint with a radial stress.
- X-rays can show subluxation or opening up of the joint, or a small bony avulsion fragment
- An MRI scan can help determine the extent of the ligament tear.
- Grade I and II tears can be treated non-operatively with the use of plasters and splints
- Grade III tears require surgical intervention to reattach the ligament to the base of the thumb, as it is usually sitting above the adductor aponeurosis (Stennar Lesion)
- Surgery is done under general anaesthetic and the ligaments reattached to the bone using a bone anchor
- Chronic tears greater than three months, often require reconstruction using spare tendon of the forearm
- Infection, Haematoma, neurovascular injury
- Stiffness to the MCP joint
- Ongoing pain in the joint
Post Op Care
- Patient will awake from surgery in a thumb spica slab
- Seen at 10 days for removal of sutures and to go into a thermoplastic splint or thumb spica cast for a total of six weeks
- A strengthening programme for six weeks to three months under the care of the hand therapist.
- Specialist review at 10 days and six weeks, and three months.