![]() Only the difference between a partial and a total rupture can be diagnosed with a physical examination. In this case, one can decide to immobilize the hand and re-evaluate it after a week, with or without using Oberst anesthesia. Sometimes the swelling during initial presentation can stand in the way of performing a reliable physical examination. described how Oberst anesthesia (in which 1–2 ml of lidocaine is injected in the MCP joint on the ulnar and radial side) increases the clinical accuracy from 28% to 98% after an average of one week after the initial trauma. Performing the investigation under local anesthesia can be useful. Often the examination is too painful to perform and the results cannot be interpreted correctly because of an uncooperative patient. ![]() However, this can only be reliable when the investigator has enough clinical experience with testing the UCL. in a recent review was that instead of holding on to a fixed degree limit, the absence of a firm endpoint during testing is a more reliable criterion when clinically diagnosing a complete rupture of the UCL. In flexion this was seen in 22% and 3% of patients, respectively. However, in a recent study in which laxity in healthy test subjects was tested, it was found that 34% of all people have a more than 10-degree left-right difference in extension, and 12% had a difference of 15 degrees or more. In most of the literature the standard is more than 35 degrees during valgus stress and/or more than a 15 degrees difference compared to the contralateral side to diagnose a total rupture. It is difficult to say when a true laxity of the joint is seen, because the normal range of motion of the MCP joint differs per individual. Next to the PCL and ACL, the shape of the joint, the dorsal capsule and the volar plate make up the static components. They can be divided into static and dynamic components. However, there are other components that also take part in creating stability in the joint. Together they ensure the ulnar and volar stability of the base of the thumb. The ACL has its origin just palmar of the PCL and runs parallel to the PCL to its insertion on the proximal phalanx (Figure 1). The PCL has its origin proximal to the base of the head of the MCP-1 joint and its insertion on the volar side of the proximal phalanx. The ulnar collateral ligament is made up of two parts, the proper collateral ligament (PCL) and the accessory collateral ligament (ACL). In children, who still have an immature skeleton, hyperabduction trauma mostly leads to a Salter-Harris III avulsion of the UCL insertion and rarely to a true rupture of the UCL. Another sport, especially soccer or fighting, was the cause in 30%. A fall on the hand, usually from a bicycle or motorcycle (in which the thumb gets stuck behind the handlebars), is the most common cause of skier’s thumb in our hospital, seen in approximately 40 % of all patients. ![]() Often, these patients also presented with a delay because their injury occurred during a holiday, and they waited until they came back home to see their own physician. ![]() During a query in our own inner-city hospital, only 10% of the patients had skier’s thumb due to an injury acquired during skiing. This type of injury is also seen in other sports, especially those that use a stick or ball, such as hockey or basketball. This makes it the most common injury of the upper extremities during skiing. Prevalence of this injury during skiing varies from 7% up to as high as 32% of all skiing injuries. Despite renewed designs for ski poles, skier’s thumb remains a common injury. Skier’s thumb refers to the fact that this injury is often seen in skiers who fall while holding on to their ski poles. It can occur with any fall on an outstretched hand when a thumb that is already in abduction receives an extra valgus stress. Skier’s thumb is the result of a hyperabduction trauma of the thumb. In the last four years, we have diagnosed approximately 85 patients in our own hospital. The incidence in the Netherlands is not known. The estimated incidence in the US is approximately 200,000 patients per year. It concerns 86% of all injuries to the base of the thumb. A partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, skier’s thumb, is an often-encountered problem.
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