Wednesday, February 20, 2008


A patient comes in with pain, tenderness, and swelling of his thumb, mostly along the ulnar aspect of the metacarpophalangeal joint. He says the thumb feels slightly unstable. You have him pinch his thumb and forefinger, and compared to the other hand, the affected one has less strength. The history is notable for a recent ski trip to Tahoe. Here's an X-ray:

Challenge: What's the diagnosis?

Related Questions:
1. What's seen on the X-ray?
2. What is the historic name for this disease and why is it called that?

Image shown under fair use.

1 comment:

Craig said...


This is an injury called gamekeeper’s thumb or skier’s thumb (originally this happened to the gamekeeper of a royal court who sustained this from twisting the necks of fowl hunted for the king). It involves an injury to the ulnar collateral ligament of the metacarpophalangeal joint, commonly seen in ski pole injuries (a fall on an outstretched hand with an abducted thumb). The X-ray also shows a fracture (bony avulsion) at the base of the proximal phalanx. Treatment involves ice therapy, immobilization, and possibly referral to an orthopedist or hand surgeon.

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