WHAT YOU SHOULD KNOW
The ligaments that stabilize the thumb where it meets the hand can be torn either partially or completely. The ligament on the inside of this group is critical for all pinch and grasp functions. If it heals loose or fails to heal, the function of that hand can become terribly incapacitated.
MEDICAL HISTORY
Patients usually can name the specific event that caused the injury, noting pain, swelling, stiffness and sometimes deformity immediately after. Failure to pinch or grasp without the thumb giving way may be obvious to the patient.
EXAMINATION
Visible swelling, loss of motion, and tenderness are usually present. The key to the examination is specific testing of the ligament’s function under stress.
ADDITIONAL TESTS
Plain x-rays are taken to prove that there are no associated fractures.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL REPAIR | SURGICAL RECONSTRUCTION | |
| CONSISTS OF | Splint immobilization | Tacking the ligament back to its original location | Rebuilding the ligament using a graft |
| FEATURES | 4-6 weeks of protection of the thumb only | Outpatient surgery, temporary pin across joint x 4 weeks | Slender tendon strip used to reconnect the attachments made by the previous ligament |
| ADVANTAGES | Avoids surgery | Solid healing with original ligament | Effective up to any time point after injury |
| DISADVANTAGES | Not effective when ligament displaced | Increased stiffness, only possible early after injury | Slightly more invasive |
RECOVERY
Sutures are removed in the office at 2 weeks. The pin across the joint is removed at 4 weeks. Exercises to increase motion are started at this time, but pinching against the ligament still must be avoided. From 6 to 10 weeks after surgery, the patient is gradually allowed to pinch more forcefully against the healing ligament until the hand is eventually strengthened. Normal activities with this hand are difficult during the first 4 weeks followed by full use for light activities not requiring forceful pinch. Heavy use of the hand is not possible until around 3 months after surgery.
