Case 1

History
The patient fell on an outstretched hand and now complains of pain at the thumb.

Diagnosis?

Diagnosis
Gamekeeper’s Thumb or Skier’s Thumb.

Findings
Soft tissue swelling is noted about the base of the thumb. There is a small, mildly displaced fracture fragment from the ulnar aspect of the base of the proximal phalanx of the first digit.

Discussion
Gamekeeper’s or Skier’s Thumb results from disruption of the ulnar collateral ligament (UCL) secondary to a valgus stress applied at the first metacarpophalangeal joint. Abduction-stress films of the thumb with UCL disruption show a first metacarpal-phalangeal angle of greater than 30 degrees. Often there is an associated avulsed bone fragment off the base of the proximal phalanx as in the current case.

A “Stener Lesion” occurs when the torn end of the UCL becomes displaced superficial to the adductor pollicus aponeurosis. MRI and ultrasound best evaluate UCL entrapment.

Reference
Greenspan,A. Upper Limb II. In: Orthopedic Radiology, 3rd ed. Lippincott Williams & Wilkins Publishers, 2000:189-190.

Submitted by Paul Clifford, M.D.
Reviewed by Robert Martinez, M.D.