1 / 15

Surgical gamekeeper’s thumb rehabilitation

Andrew Traber Jaime Miller. Surgical gamekeeper’s thumb rehabilitation. Radiographs. What is gamekeepers thumb?. It’s a sprain to the thumb’s ulnar collateral ligament This use to occur when gamekeepers broke the neck’s of rabbits by using the thumb and index finger against the ground.

lawrence-meadows
Download Presentation

Surgical gamekeeper’s thumb rehabilitation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Andrew Traber Jaime Miller Surgical gamekeeper’s thumb rehabilitation

  2. Radiographs

  3. What is gamekeepers thumb? • It’s a sprain to the thumb’s ulnar collateral ligament • This use to occur when gamekeepers broke the neck’s of rabbits by using the thumb and index finger against the ground

  4. Mechanism of Injury • Falling on an outstretched hand • Valgus force on the thumb while the thumb is abducted • Generalized ligamentous laxity

  5. Signs and Symptoms • Pain and inflammation at the ulnar site of the MCP joint • Ecchymosis • Loss of ROM compared bilaterally • Unstable joint • Inability to pinch

  6. Therapeutic Modalities • Ice cup massage to decrease pain and inflammation • Paraffin bath used to increase blood flow to the area • Ultra Sound to decrease pain and edema assuming there is no avulsion fx.

  7. Stener Lesion • Distal attachment of the UCL is avulsed from the proximal phalanx of the thumb • The avulsed part then gets trapped under the adductor apponeurosis

  8. Lifestyle: • 22 year old male collegiate football offensive lineman • Plays about six times a week for about two hours a each day • Has PH of thumb problems in the past

  9. Surgical Technique • Incision is made on the mid-lateral aspect of the ulnar side of thumb • The incision curves over the MP joint and extends proximal to the to the extensor pollicus longus tendon. • The adductor aponeurosis is identified and then detached from the EPL. • The adductor aponeurosis is then left alone until it’s time to close the wound

  10. Surgical Technique • After the add. Aponeurosis is detached the UCL is now visible. • If the tear is unable to hold a suture a pull out wire technique is then used. • If the ligament is torn at the midpoint sutures are placed with the MCP joint flexed at 15 to 20 degrees of flexion

  11. Surgical Technique • For chronic instability: A reconstruction is done by using a slip of the APL tendon. The tendon graft is fed through holes and secured above the joint.

  12. Postoperative Management/Rehabilitation • For the first 3-4 weeks the patient is put in a short arm thumb spica cast. • The cast then can be removed and the pt is put in a thumb spica splint. • Patient is advised to only take the splint off for hygiene and for rehab for the next 2 weeks.

  13. Postoperative Management and Rehabilitation • The first 4 weeks of rehabilitation will just be ROM and strengthening of the IP and MCP joints of the other 2nd -5th Digits. • We will also be working on core strengthening and cardiovascular conditioning with our athlete while he is still in the cast

  14. Postoperative Prevention

  15. Flex-a-Grip

More Related