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This patient is a 34 year old male presents to the ED with the complaint thumb after he injured it while working at the Bronx Zoo. The following ray is shown.
Questions:
Describe what you see?
- Fracture of the thumb proximal phalanx - Gamekeepers Thumb.
How does this injury typically occur?
- Gamekeeper's thumb is caused by a valgus force directed on the thumb MCP joint to produce a failure of the ulnar collateral injury. Falls on an abducted thumb are common mechanisms. Another common mechanism is the fall of a skier against a planted ski pole.
What would the physical exam show?
- Ecchymosis
- Tenderness along the ulnar aspect of the thumb, which is most exquisite at the MCP joint
- Thumb grasp and pinch are weak
What would be the management for this patient?
- Incomplete tear (<10% laxity) thumb spica cast or splint for 3-6 weeks and follow-up with hand surgery.
- Complete tear (> 10% laxity) surgical repair.
- To access joint stability apply a lateral stress to the MCP joint of the injured thumb. Then stress the normal thumb in the same manner. The presence of > 10-20% of laxity in the injured thumb when compared to the normal thumb is consistent with a complete tear and requires surgical repair.
Trivia: Since it’s the holiday season see how you do with the following trivia questions:
In "The Twelve Days of Christmas," what did your true love give to you on the eleventh day?
- A: the correct answer was Eleven Pipers Pipin'.
In which Christmas carol do we build a snowman and pretend that he is Parson Brown?
- A: the correct answer was "Winter Wonderland".
In what Christmas carol do these lines appear? "I don't know just who to blame for this catastrophe! But my one wish on Christmas Eve is as plain as it can be!"
- A: the correct answer was "All I Want For Christmas Is My Two Front Teeth".:
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