Ulnar Collateral Ligament Injuries: Diagnosis and Treatment
Injuries of the ulnar collateral ligament of the metacarpophalangeal
joint in the thumb sometimes referred to as “skier's thumb” are very
common and account for well over half of all thumb injuries. These
injuries, especially prevalent in skiers (representing nearly a third
of all skiing injuries), commonly affect participants in volleyball,
soccer, handball, basketball, and rugby as well. They are typically
the result of a fall. As people attempt to catch themselves, the
ligaments exceed their weight-bearing ability and the thumb pulls away
from the hand. In these conditions, the strong band of tissue attached
to the middle joint of the thumb sustains significant stress and
eventually tears.

Determining whether an individual suffers from skier's thumb requires
a comprehensive physical examination as well as thorough review of
one's patient history. Early diagnosis is paramount to successful
outcomes. Ulnar colateral ligament injuries are frequently overlooked
in initial diagnosis, and this inattention can limit the potential
stability of the restored joint. As such, it is necessary to pay close
attention to a patient's symptoms. Patients typically present with
swelling and pain around the joint, as well as difficulty holding or
grasping objects. Stress testing is crucial for accurate diagnosis and
may require local anesthesia to elicit full patient cooperation.
Patients suffering acute injuries may be extremely guarded, making
palpitation and, therefore, diagnosis difficult.

Much of the image diagnosis of skier's thumb relies solely on
radiographs. Though MRIs have proven accurate, there is some debate as
to whether they are cost-effective. Ultrasound, on the other hand,
holds promise. While its effectiveness can be limited by several
factors like examiner skill, quality of equipment, and the time
elapsed from injury, ultrasound has the potential to be both accurate
and cost-effective. However, more studies are necessary before
ultrasound may replace radiographs as the preferred form of imaging in
these cases.

Treatment options for ulnar collateral ligament injuries rely solely
on whether the ligament has been ruptured or only partially torn. In
cases of rupture, surgical repair is required, but partially torn
ligaments can only be treated with nonoperatively. Much of the
literature concerning treatment options has remained the same,
however, there has been rising debate concerning the management for
avulsion fractures. Some studies have demonstrated good result with
nonoperative treatment, while others have emphasized the need to
determine the stability before nonoperative treatment can be deemed
appropriate. Again, further study is required before one approach is
recognized to be superior to the other.

As common as cases of skier's thumb are, it is disheartening how often
outcomes are compromised by misdiagnosis. Hopefully, the recent
research outlined in this article offers hope for administering more
effective care for the injury in the future.
References
Michael A. Baskies, MD, Steve K. Lee, MD. Evaluation and Treatment of
Injuries of the Ulnar Collateral Ligament of the Thumb
Metacarpophalangeal Joint. In Bulletin of the NYU Hospital for Joint
Diseases. 2010. Vol. 68. Supplement 1. Pp. S44-S50.