Wrist/Hand

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General Discussion of the Hand / Wrist:
Goal Keeper's Thumb in Raleigh, Durham, Garner and the Triangle

A common finger injury among athletes, especially soccer players and skiers, is "Goalkeeper's Thumb". These finger injuries are also called "Gamekeeper's Thumb or Skier's Thumb." The mechanism of injury is usually direct forceful contact to the thumb by either a ball or another player. In skiing it involves the thumb being forced or twisted while holding the ski pole. During the actual injury, the thumb is bent backwards away from the hand and fingers.

When the thumb is bent backwards the ulnar collateral ligament stabilizing the joint pulls away from the bone, usually taking with it a fragment of bone from the attachment site at the base of the long bone of the finger known as the proximal phalanx.

Game keeper's thumb can occur in varying degrees of severity. In the event of bone fragment displacement, surgery is usually indicated. Assessment of the degree of injury and instability is more often appreciated when the patient is under anesthesia. It is not uncommon to experience less pain in complete disruptions vs partial tears.

These finger injuries at times may go unrecognized as to the degree of severity or undertreated leading to poor healing and ultimately poor stability at this joint. The thumb is equally important as the other fingers when grasping an object. The ulnar collateral ligament, the ligament affected in this injury, provides the stability to allow the thumb to aid in grasping. Failure to address the nature and severity of the injury may lead to chronic looseness at this joint, weak grip and increased predisposition to future injury.

Degree Of Injury Classification

As in other ligament finger injuries, game keeper's thumb ligament injuries can be classified as minor (Grade I), Moderate, (Grade II-Partial Tear but stable), and Severe (Grade III- Complete Tear- unstable).

X-Rays will reveal one of the following findings: -No Fracture. -Fracture - Undisplaced. -Fracture - Displaced.

Game Keeper's Thumb Treatment Options for
Raleigh, Durham, Garner and Triangle Patients

Treatment options range from conservative to surgical and depends on the severity of the ulnar collateral ligament disruption and also the position of the bone fragment usually associated with this ligament injury.

Conservative Management

In the event the joint is stable and the fracture is non-displaced, the conservative management will be immobilization. This may vary from casting to splinting for 6 weeks continuously and an additional 4-6 weeks intermittently during usage. This will allow the joint and ligament to be protected so that healing can take place in the most stable position.

Game Keeper's Thumb Surgery in Raleigh-Durham, NC

In the event the joint is determined to be unstable or a fracture is displaced, game keeper's thumb surgery will be indicated to properly fix the problem. The surgical approach usually involves a primary or direct repair fixating the ligament back to bone using various implements such as bone anchor, wire or screw.

Post Operative Management

Post operatively the thumb is immobilized in a splint for 7-10 days after which sutures are removed on the follow up visit to the clinic. Full immobilization may then be instituted using a cast for 4-6 weeks depending on the degree of injury and nature of the repair. Once immobilization period has ended, the patient may begin exercises to regain range of motion and strength but care should be taken over the next several months to protect the joint using a splint when holding or gripping objects.
 

Post Operative Results

It is not uncommon to experience some permanent stiffness in the joint after surgery. Full recovery should be accomplished over 6-8 months with slight loss of mobility at the ends of range of motion due to scarring. Surgical repair however, will provide the needed stability which is favorable over the alternative loss of function in the joint if left unattended.

Your physician and therapist can guide you in proper therapy, time healing constraints, protection and scar management.

For more information on how the game keeper's thumb specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC