When discussing sports injuries of the thumb, the typical conversation involves skier’s or gamekeeper’s thumb.
When discussing sports injuries of the thumb, the typical conversation involves skier’s or gamekeeper’s thumb. These injuries involve damage to the ulnar collateral ligament (UCL), and may be acute or chronic. Much of the literature involves anatomical evaluation, clinical exam findings, radiological imaging findings, and treatment for these injuries as these encompass the most common type of injuries to the thumb in athletes.
An analogous, surprisingly common, and relatively underreported injury in athletes is the injury to the radial collateral ligament (RCL) of the thumb. The literature in comparison to UCL injuries is limited regarding management of RCL injuries; however, it is imperative that a non-operative sports medicine provider is aware of the proper identification, management, and return to play protocol for this injury given the high risk of sequelae of improperly treated injuries. As with any musculoskeletal injury, it is critical to understand the anatomy of the involved joint and surrounding soft tissue structures to adequately treat patients.
Sports place athletes at higher risk for damaging these intrinsic ligaments of the thumb such as the RCL given increased chance of high velocity strain from various activities. As previously mentioned, soccer, football, and skiing put increased risk on the UCL of the thumb; whereas, the RCL is likely at higher risk during sports such as basketball although any injury mechanism causing traumatic force on the RCL could cause a disruption. As with any ligament that is damaged, there are varying degrees of injury from grade 1 strain, to partial tear (grade 2), to complete tear (grade3), and in most severe cases a complete tear with frank dislocation.
When evaluating an athlete with a thumb injury, it is important to obtain radiographs to evaluate for obvious fractures and subluxed or dislocated joint. A dislocated joint should be as quickly as possible reduced and splinted in anatomical position. Clinical stability should also be evaluated by placing the involved thumb joint (the proximal IP joint in this case) under stabilized radial and ulnar deviation to evaluate the RCL and UCL, respectively.
Palpation and range of motion of the involved joint as well as the joint above and below the injury- IE the distal IP joint and carpometacarpal joint is imperative. It should also be tested clinically if the flexors and extensors of the thumb are intact. The addition of musculoskeletal ultrasound can be utilized on the day of the evaluation to further provide information on ligament integrity and stability.
If you are experiencing symptoms that may be related to the uncommon common finger injuries, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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