Skier's finger injury. Collateral ligaments of the thumb - overview of functions. Preventing eye injuries

Skier's toe injury - rupture of the ulnar collateral ligament of the metacarpophalangeal joint thumb- a typical injury among skiers. This injury accounts for 8-10% of all ski slope injuries. One of the most common injuries to the lateral ligaments of the hand in athletes. The mechanism of injury to the ulnar collateral ligament is a fall on the snow, during which the thumb is forced into a position of abduction and excessive straightening.

A patient with a rupture of the ulnar collateral ligament of the thumb feels pain when performing a pinch.

A sign of a ulnar collateral ligament rupture is weakness when performing a pinch.

Stener lesion occurs when the adductor aponeurosis becomes displaced and lies in front of the torn ulnar collateral ligament at its attachment to the base of the proximal phalanx. The distal part of the ligament is retracted and located under the adductor aponeurosis. Thus, the ends of the torn ligament are separated by an aponeurosis and therefore will never heal on their own.

Product characteristics

Thanks to its special design, this orthosis fits under the skier's glove. Can be used prophylactically or as immobilization of an injured finger. Does not restrict wrist movements.

The orthosis is made of very durable water-resistant Codura fabric, so it can be used in extreme conditions. The inside has EVA foam and a cotton lining with Oeko-Tex® Standard 100 certification, which improves comfort and allows sweat to be wicked away from the body. In addition, the orthosis has elastic plastic inserts and a metal thumb splint. The orthosis is fastened with Velcro. The orthosis has 2 velcro fabric straps with buckles, which can be used to precisely fit the orthosis on the hand. After this, the excess straps can be cut off.

This is a very durable and abrasion-resistant polyamide fabric with a layer of polyurethane and a Teflon coating. The structure of the fabric and thread makes it very durable and resistant to damage and extreme conditions. Products made from this material are the thinnest and most durable on the market. The material is waterproof.

The metal splint stabilizes the metacarpophalangeal joint of the thumb and prevents sudden abduction and hyperextension of the thumb.

Purpose

rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb - so-called. "skier's finger"
instability of the metacarpophalangeal joint of the thumb at the onset of osteoarthritis
joint dislocation
after osteotomy, endoprosthetics and ligament reconstruction
Bennett's or Rolando's fracture
muscle tendinitis
prophylactically to prevent soft tissue damage

size table

Size	Wrist circumference
S	13-15 cm
M	15.5-17 cm
L	17.5-19 cm
XL	19.5-21 cm

The product is available for left and right hands

One of the most common injuries to the lateral ligaments of the hand is a rupture of the ulnar collateral ligament of the thumb. This injury is also called “skier's thumb” or “gamekeeper's thumb.” The term "skier's finger" is more applicable to acute injury, and "gamekeeper's finger" to chronic injury. The term "jaeger's finger" (i.e. "jaeger's thumb") originated in 1955. in describing the chronic thumb injury of gamekeepers in Scotland who killed wounded rabbits with cervical dislocation honeydew

, squeezing their neck into a fist, between the base of the large and index finger(Demirel M. and al., 2006).

Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is a common injury in alpine skiers. This type of injury also occurs in contact sports (boxing), as well as sports in which falls on the hands are possible. This injury to skiers was first described back in 1939 by Petitpierre.

Injury to the ulnar collateral ligament of the first finger is the second most common (9.5%) and common injury upper limbs(37.1%) in downhill skiing.

The mechanism of injury to the ulnar collateral ligament is a fall on the snow, during which the thumb is forced into a position of abduction and excessive straightening. As the skier's instinctive attempt to break the fall with an outstretched arm, holding the ski pole places the thumb in a vulnerable position (Figure 1).

In this regard, they began to recommend the use of ski poles that do not have straps, which allows the skier to free himself from the pole if he falls. Ski manufacturers have created ski poles with the "new capture", however this did not completely solve the problem.

Similar injuries can happen in other sports. For example, in ice hockey, when any forces move the player’s stick in such a way that it critically pulls the thumb back. In handball, volleyball and goalkeepers in football, such an injury is also possible when, when catching a ball at high speed, the thumb is pulled back excessively.

The metacarpophalangeal joint of the thumb is unique in its anatomy and functional biomechanics. Stability of this joint is necessary for a powerful grip, creating leverage. Its mobility varies greatly: some are able to extend it excessively, others do not achieve full extension. The flexion angle ranges from 5 to 115°. The radial deviation can be 0-30° in the straightened position and 0-15° in the full flexion position.

phalanges of the thumb.

Damage to the ulnar collateral ligament in skiers was: 34.8% first degree - microscopic rupture of the fibers of the ulnar collateral ligament without loss of integrity; up to 47% second degree - partial rupture fibers without violating their integrity, but with their elongation; up to 18.2% third degree - complete rupture, usually at the distal

end near the entry point into the proximal phalanx. In addition, a fracture was observed in 23.3% of cases.

A thorough examination of an athlete with a potential for joint injury is very important. great importance for accurate diagnosis and prescribing timely and appropriate treatment. Neglecting an injury can lead to undesirable consequences - serious and chronic impairment of function.

After an injury to the ulnar collateral ligament, the victim may complain of pain and swelling in the area of the ulnar part of the metacarpophalangeal joint. If the physician suspects an ulnar collateral ligament injury (based on the patient's complaints), an x-ray should be taken to determine whether an avulsion fracture has occurred (Figure 3). If such a non-displaced fracture is identified, immobilization is carried out; if displacement occurs, surgical intervention may be required. If the bone is not damaged, then the victim is monitored with clinical examination and assessment of joint stability. Testing of the radial load on the joint is carried out in extended and bent positions. The results obtained are compared with the results shown by the other limb. Lack of stability at 0° extension indicates loss of integrity of the accessory collateral ligament with the volar plate. Instability during flexion indicates a violation of the integrity of the ulnar collateral ligament itself.

Stener damage

Some experts, after identifying an avulsion fracture, recommend using a joint x-ray as a means of diagnosing a ulnar collateral ligament tear. This allows not only to determine its complete rupture, but also to differentiate a ligament rupture from a Stener injury. A Stener lesion occurs when the adductor aponeurosis becomes displaced and lies in front of the torn ulnar collateral ligament at its attachment to the base of the proximal collateral ligament. phalanx. Distal part of the ligament is retracted and located under the adductor aponeurosis (Fig. 4, B). Thus, the ends of the torn ligament are separated by an aponeurosis and therefore will never heal on their own. With such a displacement of the adductor aponeurosis, surgery on restoration correct position ligament and adductor aponeurosis.

The lack of such a specific diagnosis may explain why some patients had good results when applying plaster cast(without displacement), and in others it is very bad (in patients with a displaced ligament and with interposition of the adductor aponeurosis). There is also concern that intensive joint stability testing may lead to Stener injury in the previously undisplaced ulnar collateral ligament, necessitating surgical intervention.

Treatment of ulnar collateral ligament injury

Immediately after an injury, the athlete should ice the joint and keep the thumb elevated to avoid Stener injury. Contact your doctor immediately.

In case of a first degree injury, a splint is applied to the forearm or hand until it disappears pain; in case of second degree damage, a plaster cast is applied for 3-4 weeks; in case of third degree damage with divergence of the ends of the ligament, a plaster cast is applied for 4-6 weeks. In case of severe instability of the joint, surgical treatment is performed, which is carried out in the first few weeks after the acute injury. The essence of the operation is to apply a removable wire suture to a torn or torn ligament along with the bone plate (Fig. 5) or fixation of the torn fragment using Kirschner wires

(Demirel M. and al., 2006).

During the course of treatment, the athlete can resume training sessions skiing and other sports activities when applying a protective plaster cast or splint. A plaster or splint is placed on the thumb so as to cause radial deflection forces on the proximal phalanx, as well as ulnar deviation of the first metacarpal bone under the influence of the first dorsal

interosseous muscle, which can cause indirect abduction of the metacarpophalangeal joint. Thumb apposition should be avoided as this may lead to abduction of the metacarpophalangeal joint. The metacarpophalangeal joint should be flexed at about 30°, while the interphalangeal joint should be flexed at an angle of 20°.

The fiberglass cast should be stiff enough to allow return to skiing with minimal risk of re-injury. The splint does not provide adequate mobilization and protection. The splint can be used after removal of the plaster cast to protect the injured area during physical activity. It can be secured using elastic material. Application protective equipment Once treated, second to third degree injuries can be discontinued after approximately 8 to 12 weeks.

After 4-6 weeks the athlete can return to training, provided full recovery(this is determined by the attending physician), having previously completed a course of physical therapy.

Untreated injury to the ulnar collateral ligament can cause intermittent or permanent instability of the joint, weakening of the grip, and also lead to arthrosis

joint Surgery advanced cases often gives good results. Prevention of ulnar collateral ligament injury

The damage may be caused by a ski pole. This conclusion was made on the basis of subjective information and observations, which showed that only 5% of skiers who held poles without grasping the straps were injured. These data speak in favor of this particular method of holding ski poles. Therefore, the straps on the poles should either be removed altogether or placed on the outside of the pole. This will allow you to get rid of the stick when it falls on the snow. Skiers should discard their poles when falling.

Eisenberg et al. studied a specially designed system for protecting the thumb from damage to the collateral ligament - built into a ski glove protective device. It allowed all the normal movements of the thumb, but prevented excessive stress on the elbow. In preliminary studies, 170 thousand person-days of skating (the sum of all days of skating for all athletes studied) were recorded with a protective system without a single thumb injury, compared to 1 thumb injury per 8 thousand person-days without the use of such protection. .

References

Sports injuries. Clinical practice prevention and treatment/ under general ed. Renström P.A.F.H. - Kyiv, “Olympic Literature”, 2003.
Traumatology and orthopedics/Guide for doctors. In 3 volumes / ed. Shaposhnik Yu.G. - M.: “Medicine”, 1997.
Sport Injuries: their prevention and treatment/ L. Peterson & P. Renstrom - published by "Martin Dunitz", London, 1995.
Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical treatment of skier's thumb injuries: case report and review of the literature. 2006, Mt Sinai J Med. vol.73, no.5, pp.818-821
O"Callaghan BI, Kohut G, Hoogewoud HM. Gamekeeper thumb: identification of the Stener lesion with US. 1994, Radiology. vol.192, no.2, pp.477-480
Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, Dislocations, and Thumb Injuries. 2006, Am Fam Physician. vol.73, no.5, pp.827-834.

, squeezing their neck into a fist, between the base of the thumb and index finger (Demirel M. and al., 2006).

Injury to the ulnar collateral ligament of the first finger is the second most common (9.5%) and common upper extremity injury (37.1%) in downhill skiing.

In this regard, they began to recommend the use of ski poles that do not have straps, which allows the skier to free himself from the pole if he falls. Ski manufacturers have created ski poles with a “new grip”, but this has not completely solved the problem.

phalanges of the thumb.

Damage to the ulnar collateral ligament in skiers was: 34.8% first degree - microscopic rupture of the fibers of the ulnar collateral ligament without loss of integrity; up to 47% of the second degree - partial rupture of fibers without violating their integrity, but with their elongation; up to 18.2% third degree - complete rupture, usually at the distal

end near the entry point into the proximal phalanx. In addition, a fracture was observed in 23.3% of cases.

A thorough examination of an athlete with a potential joint injury is critical to an accurate diagnosis and prompt and appropriate treatment. Neglecting an injury can lead to undesirable consequences - serious and chronic impairment of function.

After an injury to the ulnar collateral ligament, the victim may complain of pain and swelling in the area of the ulnar part of the metacarpophalangeal joint. If the physician suspects an ulnar collateral ligament injury (based on the patient's complaints), an x-ray should be taken to determine whether an avulsion fracture has occurred (Figure 3). If such a non-displaced fracture is identified, immobilization is carried out; if displacement occurs, surgical intervention may be required. If the bone is not damaged, then the victim is monitored with a clinical examination and assessment of joint stability. Testing of the radial load on the joint is carried out in extended and bent positions. The results obtained are compared with the results shown by the other limb. Lack of stability at 0° extension indicates loss of integrity of the accessory collateral ligament with the volar plate. Instability during flexion indicates a violation of the integrity of the ulnar collateral ligament itself.

Stener damage

Some experts, after identifying an avulsion fracture, recommend using a joint x-ray as a means of diagnosing a ulnar collateral ligament tear. This allows not only to determine its complete rupture, but also to differentiate a ligament rupture from a Stener injury. A Stener lesion occurs when the adductor aponeurosis becomes displaced and lies in front of the torn ulnar collateral ligament at its attachment to the base of the proximal collateral ligament. phalanx. Distal part of the ligament is retracted and located under the adductor aponeurosis (Fig. 4, B). Thus, the ends of the torn ligament are separated by an aponeurosis and therefore will never heal on their own. With such a displacement of the adductor aponeurosis, a surgical operation is performed to restore the correct position of the ligament and the adductor aponeurosis.

The lack of such a specific diagnosis may explain why some patients have good results with a cast (without displacement) and others have very poor results (patients with a displaced ligament and interposition of the adductor aponeurosis). There is also concern that intensive joint stability testing may lead to Stener injury in the previously undisplaced ulnar collateral ligament, necessitating surgical intervention.

Treatment of ulnar collateral ligament injury

Immediately after an injury, the athlete should ice the joint and keep the thumb elevated to avoid Stener injury. Contact your doctor immediately.

In case of a first degree injury, a splint is applied to the forearm or hand until pain disappears; in case of second degree damage, a plaster cast is applied for 3-4 weeks; in case of third degree damage with divergence of the ends of the ligament, a plaster cast is applied for 4-6 weeks. In case of severe instability of the joint, surgical treatment is performed, which is carried out in the first few weeks after the acute injury. The essence of the operation is to apply a removable wire suture to a torn or torn ligament along with the bone plate (Fig. 5) or fixation of the torn fragment using Kirschner wires

(Demirel M. and al., 2006).

While undergoing treatment, the athlete can resume skiing and other sports activities while wearing a protective plaster cast or splint. A plaster or splint is placed on the thumb so as to cause radial deflection forces on the proximal phalanx, as well as ulnar deviation of the first metacarpal bone under the influence of the first dorsal

The fiberglass cast should be stiff enough to allow return to skiing with minimal risk of re-injury. The splint does not provide adequate mobilization and protection. The splint can be used after the cast is removed to protect the injured area during physical activity. It can be secured using elastic material. The use of protective equipment after treatment of second or third degree injuries can be discontinued after approximately 8-12 weeks.

After 4-6 weeks, the athlete can return to training, subject to complete recovery (this is determined by the attending physician), having previously completed a course of physical therapy.

Untreated injury to the ulnar collateral ligament can cause intermittent or permanent instability of the joint, weakening of the grip, and also lead to arthrosis

joint Surgical treatment of advanced cases often gives good results. Prevention of ulnar collateral ligament injury

Eisenberg et al. studied a specially designed system for protecting the thumb from collateral ligament injury by incorporating a protective device into a ski glove. It allowed all the normal movements of the thumb, but prevented excessive stress on the elbow. In preliminary studies, 170 thousand person-days of skating (the sum of all days of skating for all athletes studied) were recorded with a protective system without a single thumb injury, compared to 1 thumb injury per 8 thousand person-days without the use of such protection. .

References

Sports injuries. Clinical practice of prevention and treatment/ under general ed. Renström P.A.F.H. - Kyiv, “Olympic Literature”, 2003.
Traumatology and orthopedics/Guide for doctors. In 3 volumes / ed. Shaposhnik Yu.G. - M.: “Medicine”, 1997.
Sport Injuries: their prevention and treatment/ L. Peterson & P. Renstrom - published by "Martin Dunitz", London, 1995.
Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical treatment of skier's thumb injuries: case report and review of the literature. 2006, Mt Sinai J Med. vol.73, no.5, pp.818-821
O"Callaghan BI, Kohut G, Hoogewoud HM. Gamekeeper thumb: identification of the Stener lesion with US. 1994, Radiology. vol.192, no.2, pp.477-480
Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, Dislocations, and Thumb Injuries. 2006, Am Fam Physician. vol.73, no.5, pp.827-834.

Thumb ligament rupture accounts for 10% of all ski injuries
The thumb of the hand moves dorsally and laterally due to the application of force, for example, when sharply picking up a ski pole
Rupture of the collateral ulnar ligament in the area of the metacarpophalangeal joint of the thumb
Intraligamentous rupture or bone avulsion (more often distal than proximal) Complications are possible if the free proximal end of the ligament is directed under the tendon aponeurosis of the adductor pollicis muscle (Stener injury), which impedes healing and leads to the development of chronic instability of the joint.

Which method of diagnosing a skier's fracture to choose: MRI, CT, X-ray Method of choice

X-ray examination.

What will they show x-rays with a skier's fracture

X-ray examination in two projections
If a fracture is excluded, a stress x-ray examination
Examination of both hands: comparison of the damaged and healthy sides
Severance of a bone fragment due to rupture of the thumb ligaments
The degree of opening (relaxation) of the joint exceeds 28° or the difference between the injured and uninjured side is more than 20°.

What will MRI images of the hand show in a “skier” fracture?

MRI only if there is doubt about the diagnosis or an old rupture
Frontal and axial imaging using T1-weighted and T2-weighted fat-suppressed sequences
Ulnar collateral ligament rupture
Possible bone avulsion
Possible displacement of the proximal end of the ligament (damage Stener).

Pain syndrome in the metacarpophalangeal joint of the thumb after increased abduction of the thumb when falling from skis. X-ray examination in the dorsal projection demonstrates the avulsion of an elongated fragment of bone from the ulnar side at the base of the proximal phalanx of the thumb.

A, b Falling with a ski pole in hand while skiing. ( a ) Dorsal X-ray demonstrates ossification of the radial aspect of the distal first metacarpal following previous trauma. A fresh fracture is not detected.

( b ) Projection with radial abduction. 37° metacarpophalangeal joint inclination

Clinical manifestations

Typical manifestations of skier's toe or thumb ligament rupture

Pain on palpation
Soft tissue swelling
Hematoma
The range of motion may be limited.

Treatment methods

Incomplete rupture of the ulnar collateral ligament is treated by immobilizing the metacarpophalangeal joint using a thumb splint for 4 weeks.
If there is a complete rupture of the thumb ligament or if there is a bone avulsion, and there is a suspicion of a Stener lesion, treat for the first 10 days with repair of the ligament by suturing.
At avulsion fractures transosseous cerclage, stitching or fixation (wire, screw, fixator).

Course and prognosis

Failure to treat or improperly managed skier's toe results in limited function (eg, inability to grasp a bottle) with chronic instability of the metacarpophalangeal joint ("floppy joint") and dysfunction that may extend to the entire hand.

What the attending physician would like to know

Bone lesion
The degree of joint opening (relaxation).

What diseases have symptoms similar to thumb ligament rupture

Fracture and/or dislocation of the phalanges and metacarpal bones are clearly visualized by X-ray examination.

In the stress view, careful dorsal projection of the metacarpophalangeal joint of the thumb and correct positioning of the metacarpal bone in relation to proximal phalanx necessary so that stress exposure can be assessed by radiographic examination.

To begin with, let’s remember the names of the two joints, the ligaments of which will now be discussed. The metacarpophalangeal joint is the middle joint of the thumb, and the interphalangeal joint is the distal joint of the thumb. These joints are strengthened by four collateral ligaments: two ulnar collateral ligaments and two collateral radial ligaments.

ULNA COLLATERAL LIGAMENT OF THE MACETARPHALANGEAL JOINT OF THE THUMB

The first ulnar collateral ligament attaches to the medial side of the metacarpophalangeal joint, right next to the membrane between the greater and index finger. Its function is to attach the two bones of the thumb together on the medial side to limit its ability to bend laterally (try this movement thumb, and you will understand that this is almost impossible).

This thumb ligament is most often injured when various injuries. Chronic sprain of this ligament is called “jaeger's toe,” a term coined in the 1950s when large quantity Scottish gamekeepers diagnosed this injury. Besides, acute injuries This ligament is called the “skier’s finger”, since the ulnar collateral ligament of the metacarpophalangeal joint is often injured when a person, holding ski poles secured with loops on the hands, falls sharply - this often happens to both amateur and professional skiers. If this ligament is damaged, even the simplest actions involving the thumb cause pain - it is difficult to grab something with your hand or even take a pinch of salt.

RADIAL COLLATERAL LIGAMENT OF THE MACETARPHALANGEAL JOINT

The radial collateral ligament of the metacarpophalangeal joint, located on the lateral side of the big toe, can also be injured in some cases. However, these types of injuries are much less common than ulnar collateral ligament injuries because the radial collateral ligament is not as easily or frequently strained.

If any ligament of the thumb is damaged, any movement of it causes pain. The area around the joint may become swollen. As a result, the person has to use the thumb less frequently during daily activities.

activity, which causes atrophy of his muscles. In addition, damaged ligaments can no longer hold the bones firmly in place, which can result in instability of the thumb. Over time, degenerative processes can occur in the metacarpophalangeal joint, leading to osteoarthritis.

ULNA COLLATERAL LIGAMENT OF THE INTERPHALANGEAL JOINT

The ulnar collateral ligament of the interphalangeal joint is very small in size, but its importance cannot be underestimated - it stabilizes the medial side of this distal joint of the thumb. It limits valgus movement in the joint (outward). This ligament is also very often injured during sports.

The radial collateral ligament of the interphalangeal joint stabilizes the lateral aspect of this distal thumb joint. It limits varus movement in it (inward). Try moving your thumb, assessing the mobility of the interphalangeal joint. First, make a few movements in this joint, using it as a hinge - bend and extend the distal phalanx of the thumb. You will be able to bend your finger by about 80-90 degrees, and straighten it no more than 20-40 (many people cannot straighten their thumb at this joint at all). Then take the distal part of the thumb by the nail and try to bend it from side to side - you will see that such movement in the joint is almost impossible due to two important collateral ligaments - together they help protect the joint from damage by limiting movement to the side (lateral movement).

Then bend your finger at the metacarpophalangeal joint - the range of mobility should also be about 80-90 degrees. You will practically not be able to straighten your thumb at the metacarpophalangeal joint. Again, side to side movement is greatly limited due to the collateral ligaments.