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Orthopedic Sports Medicine (Expert Forum)
ulnar collateral ligament chronic sprain (thumb)
Answered by
Michael L Gross, MD - Orthopedic Surgery, Sports Medicine, Arthroscopic Surgery, Athletic Trauma
Active Orthopedics & Sports Medicine
Hackensack,Westwood - NJ
Questions in the Orthopedic Sports Medicine forum are answered by Michael L. Gross, MD the CEO of Active Orthopedics & Sports Medicine.
ulnar collateral ligament chronic sprain (thumb)
by redpony77, Apr 12, 2009 11:51AM
My son sprained his thumb 2 years ago during spring football and was treated by wearing a cast for 6 wks, and then a splint and PT/OT. He completed his rehab and the thumb was fine until football season started. He has since injured it several times but hasn't seeked treatment since he wanted to play (he was a starting offensive lineman) and felt that he wouldn't heal anyway. So he has reinjured it several times and has never really completely healed.
He recently hurt it (not in football this time) and decided to see a doctor. After physical manipulation the doctor said that his laxity (the thumb can twist, turn, and bend in ways it definitely should not--it's pretty gross to watch) was indicative of torn ligaments and ordered an MRI. Here's where the story gets a little weird... the MRI tech called my son in on three different occasions to 'retake' the MRI because the doctor was sure that there were torn ligaments based on the physical examination and couldn't believe that nothing showed up on the MRI. They finally decided there weren't any torn ligaments and only some swollen and irritated ones so they ordered OT for my son.
Here's my problem... my son feels like the same thing will happen that occurred before--he'll do all of his OT and regain the strength in the thumb and then as soon as he starts playing football in the fall (in college now) it will happen again. He doesn't want to wear the spica the OT made for him but he is doing the exercises religiously. I'm concerned that it won't heal if he doesn't wear the spica since it is supposed to limit the movement that seems to cause him the most pain. On the other hand, I can see his point, too. He believes that it is all going to be a waste of time since it didn't work well before.
Should we seek a second opinion? Is there something the doctor's office might have missed? My son is having trouble opening doorknobs, using keys to unlock doors, writing, and anything that requires pinching.
He recently hurt it (not in football this time) and decided to see a doctor. After physical manipulation the doctor said that his laxity (the thumb can twist, turn, and bend in ways it definitely should not--it's pretty gross to watch) was indicative of torn ligaments and ordered an MRI. Here's where the story gets a little weird... the MRI tech called my son in on three different occasions to 'retake' the MRI because the doctor was sure that there were torn ligaments based on the physical examination and couldn't believe that nothing showed up on the MRI. They finally decided there weren't any torn ligaments and only some swollen and irritated ones so they ordered OT for my son.
Here's my problem... my son feels like the same thing will happen that occurred before--he'll do all of his OT and regain the strength in the thumb and then as soon as he starts playing football in the fall (in college now) it will happen again. He doesn't want to wear the spica the OT made for him but he is doing the exercises religiously. I'm concerned that it won't heal if he doesn't wear the spica since it is supposed to limit the movement that seems to cause him the most pain. On the other hand, I can see his point, too. He believes that it is all going to be a waste of time since it didn't work well before.
Should we seek a second opinion? Is there something the doctor's office might have missed? My son is having trouble opening doorknobs, using keys to unlock doors, writing, and anything that requires pinching.
Doctor's Answer
by Michael L Gross, MD, Apr 19, 2009 06:55AM
, Apr 19, 2009 06:55AMTo: redpony77
It certainly sounds as if there is a problem. From your description, it sounds like this could be a chronic laxity of the ligament at the base of the thumb, the ulna collateral ligament (UCL). This injury is known as a "gamekeeper's thumb", named for the game wardens in old England who developed chronic laxity in the UCL after using their thumbs to break the necks of rabbits before slaughter.
Although the exercises can be helpful, the brace or taping is important to prevent further secondary injury to the surrounding structures at the base of the thumb. Certainly in a contact sport such as football, bracing or taping is important. Since he is a down lineman, I dont think the brace will limit his play in any way.
As far as the MRI, it should not be confused with or substituted for a thourough history and physical examination. MRI's can give "false negative" results. The decision for surgery, should be made based on all the data available, not simply on the MRI results. In your son's case, he has exhausted conservative management, and is now having symptoms with activity of daily living.
A second opinion with a hand specialist is never a bad idea.
Although the exercises can be helpful, the brace or taping is important to prevent further secondary injury to the surrounding structures at the base of the thumb. Certainly in a contact sport such as football, bracing or taping is important. Since he is a down lineman, I dont think the brace will limit his play in any way.
As far as the MRI, it should not be confused with or substituted for a thourough history and physical examination. MRI's can give "false negative" results. The decision for surgery, should be made based on all the data available, not simply on the MRI results. In your son's case, he has exhausted conservative management, and is now having symptoms with activity of daily living.
A second opinion with a hand specialist is never a bad idea.
