Ask an Expert: UCL rupture/gamekeeper`s thumb

Sports Medicine

UCL rupture/gamekeeper`s thumb
02/18/2008

Question:

My 11 year old son ruptured his UCL. The radiologist`s report from the MRI states that there is a "tear that is partial OR potentially complete but not displaced. The UCL is torn although it is not significantly retracted or balled up and no discrete evidence of adductor aponeurosis entrapment is identified."
What I`ve read about UCL ruptures states that complete tears need to be repaired surgically. Because it`s not displaced, is the appropriate treatment to cast and immobilize the thumb whether the tear is partial or complete?

Answer:

If you've not already done so, you really must pose this question to your son's treating orthopedist, who has the necessary advantage of having examined your son. Since the MRI indicates the UCL tear may be partial, if his exam indicates he most likely has a partial tear, his treatment would be nonsurgical (cast or splint 24 hrs/day for 4-6 wks.). A complete UCL tear can be treated nonsurgically if:

there is no displacement of the torn ends of the ligament,

if only the "proper" but not the "accessory" UCL ligament are torn (the thumb UCL has two components), and

if there is no adductor aponeurosis entrapment (referred to as a "Stener lesion").

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Response by:

Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University