QT Pathologies (EN)
A sprain refers to an injury to the tissues surrounding and supporting a joint. This includes the ligaments and joint capsule.
The ligaments are strong structures that prevent the joint from going into abnormal positions. The capsule is a less strong structure that seals the joint from the other tissues.
A sprain can be of varying degrees. In a minor sprain the tissues essentially remain intact and recover rapidly, in a more serious sprain the tissues may be badly torn and sometimes need to be repaired surgically.
- Collateral ligaments of the thumb Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com
These types of injuries are common in sports and falls. The thumb is jammed into another player, the ground, or the ball. The thumb may be bent in an extreme position, causing a sprain. The thumb will usually swell and may show bruising. It is usually very painful to move.
The most common ligament to be injured in the thumb is the ulnar collateral ligament. Injury to this ligament is sometimes called "skier's thumb" because it is a common skiing injury. It occurs when the skier falls and the pole acts as a fulcrum in the hand to bend the thumb in an extreme position. This ligament may also be injured by jamming the thumb on the ground when falling or by jamming the thumb on a ball or other player. The radial collateral ligament may also be injured. It is much less commonly injured than the ulnar collateral ligament.
Less often there is no specific injury and the cause is due to a chronic stretching of the ligament. This is referred to as a 'gamekeeper's thumb'. Patients with this problem complain of a loss of strength when pinching or gripping with the thumb.
The thumb will be swollen, bruised and painful.
Your surgeon will then examine the thumb to determine whether the ligament is partly or completely torn and, if it is torn, whether the ligament has displaced into a position where healing may not be possible (Stener lesion).
Making this decision may be possible with a gentle examination but it can be hard to decide as the thumb is sore and swollen.
Other methods can be used to help with assessing the degree of injury. One maybe to inject some local anaesthetic around the thumb and to then examine the joint again.
An x-ray may help if there is a fracture of a small fragment of bone which the ligament is attached to. Displacement of this fracture may indicate a complete tear.
An ultrasound examination can help.
If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is used to get the thumb moving again. It can take several months for the movement and the strength to return.
Occasionally the ligament does not heal properly and the thumb becomes weaker and unstable. If this is a problem further surgery to reconstruct the ligament or fuse the joint can be done.
If the ligament is completely torn then an operation to repair the ligament will be performed. This is followed by a similar period of splinting and subsequent exercise programme.
For some patients it is recommended to use a splint to support the thumb after this type of injury when undertaking sport or heavy activity.
During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.