What do you recommend for a severe skier's thumb? I tried wearing a cast for six weeks but it still hurts terribly and I can't really pick anything up with that hand.
Skier's thumb refers to an injury affecting the ulnar collateral ligament (UCL) of the thumb.Partial tears can be treated nonoperatively with conservative care. But complete ruptures (which it sounds like you may have) often require surgical repair.
The surgery can be done on an outpatient basis under a regional or general anesthesia. Sometimes the ligament can be repaired by reattaching it to the bone. If the ligament ruptured and pulled away a piece of bone with it, the additional injury is referred to as an avulsion fracture.
Small avulsion fractures can also be repaired this way with special sutures used to anchor the bone fragment in place. Any damage to the other soft tissues or joint capsule can be repaired at the same time. If the damage is too great to repair the problem, then a tendon graft may be needed to reconstruct the joint. No matter whether it's a surgical repair or reconstruction, the goal is to return everything to as normal an anatomical orientation as possible. This will ensure a return of normal joint kinematics (movement).
The patient is put in a cast and immobilized for six weeks after surgery. When the cast is taken off, the pins and wires holding everything together can be removed. A hand therapist helps the patient get started with range-of-motion exercises. The therapist progresses the rehab program through strengthening and return to full activities without restrictions. All of this takes at least three months for a safe and effective result.
Studies show that this approach is quite successful. The earlier the repair is made, the better the results. Returning to activities when the thumb is unstable can cause further damage that could have been avoided with early diagnosis and treatment. Ninety per cent of the time, the results are good-to-excellent with surgical repair.
Michael A. Baskies, MD, and Steve K. Lee, MD. Evaluation and Treatment of Injuries of the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint. In Bulletin of the NYU Hospital for Joint Diseases. March 2009. Vol. 67. No. 1. Pp. 68-74.
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