Game Keeper's Thumb

A presentation of a patient with Game Keeper's Thumb

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Scenario: The patient is a 22-year-old competitive downhill skier who injured herself during a fall on the slopes. She reports that her thumb was forced outward by the ski pole as she fell. She was taken to the emergency complaining of pain and inability to use the thumb. It was determined that a partial rupture of the UCL of her L thumb at its proximal insertion had occurred, and that conservative treatment was indicated. She was provided with a cast to the hand which held the thumb midway between radial and palmar abduction, and in approximately 5 degrees MP flexion, with the IP joint free. She presents to the clinic 3 weeks later. 

The patient has focal swelling and tenderness at the medial aspect of the first metacarpophalangeal (MCP) joint. She is having difficulty with grasping kitchen utensils and drinking cups and difficulty turning doorknobs due to pain and weakness of the thumb. The patient presents with grade II laxity during a valgus stress test at 30 degrees of the first MCP joint.

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Question: What would be the most appropriate splint to prescribe for this patient?  

Potential answers: 

a.    Dynamic thumb splint with functional electrical stimulation  

b.    Static progressive thumb splint  

c.    Serial static thumb splint 

d.    Spica splint 

Answer with rationale: Spica splint.1 

The thumb needs to be immobilized to allow the ulnar collateral ligament of the thumb to heal, as well as any fractures that may be present. Most common duration for splinting is 4-6 weeks, with the splint being removed for physical or occupational therapy.1,2 

References:  
  1. Shamus E. The Color Atlas of Physical Therapy. McGraw-Hill;2015. Updated: 2014. Accessed September 5, 2021. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=1491&sectionid=90315539
  2. Knight J. Gamekeeper’s Thumb Symptoms & Treatment. The Hand and Wrist Institute. Updated: 2021. Accessed: October 1, 2021. https://handandwristinstitute.com/gamekeepers-thumb-surgeon-dallas/ 

For more information see Chapter 174 Game Keeper's Thumb in The Color Atlas of Physical Therapy

Eric Shamus, DPT, PhD

Professor, Chair of Department of Rehabilitation Sciences, Florida Gulf Coast University