2.  CC: R thumb pain
 HPI: 32 yo right-handed male
presents to the ED s/p skiing
accident complaining of R thumb
pain. Patient admits to losing his
balance on the slopes one hour
ago, he was holding onto his ski
pole tightly when he landed on his
R hand. He admits that his R
thumb was pulled away from the
ski pole during the fall. He
complains of R thumb pain since
fall. He admits to swelling in the
area and has had a difficulty time
untying his skis since the event.
He denies any other injuries or
LOC.
VS: T: 97.1 P: 78 R: 18 BP:
140/84 O2: 95%RA
Musculoskeletal: RUE:
2+radial pulse. Ecchymosis
over thenar eminence and
TTP about 1st digit MCP.
Decreased pincer grasp
noted. Flexion/extension
intact about thumb PIP.
Otherwise normal
motor/sensory function

4. Avulsion of UCL (ulnar collateral ligament) of the thumb
Also known as Skier’s thumb

5.  Thumb spica splint placement and urgent hand
surgery follow-up (the patient who suffers an acute
UCL injury is more likely to undergo and respond to
UCL surgical repair)
 Pain Control

6.  6 different Classifications of UCL avulsions, based on
stability
 Stener Lesion –dislocation of the torn end of the
ligament dorsally above the adductor
aponeurosis/adductor pollicis muscle such that it is
separated from the joint –indication for surgical repair
 Acute tears (skier’s thumb) have better prognosis than
chronic (gamekeepers)

7. 
type I



type II



no fracture but unstable
requires surgery
type V



no fracture present and the joint is stable in flexion
typically treated with a splint / cast
type IV



displaced fracture present
requires surgery
type III



fracture present, which is non-displaced & stable in flexion
typically treated with a splint / cast
fracture present, involving the volar plate, but stable in flexion
typically treated with a splint / cast
type VI


fracture present, involving the volar plate; unstable
requires surgery

8.  Type 1 Skier’s Thumb

9. Koval, K. et al. Handbook of Fractures. 4th Edition. 2010.
Northwestern University School of Medicine: Emergency
Medicine Residency Orthopedic Teaching Files
http://www.feinberg.northwestern.edu/emergencymed/res
idency/ortho-teaching/
Wheeles Ortho online
textbook http://www.wheelessonline.com/
http://radiopaedia.org/articles/gamekeepers-thumb