KEMBLE WANG - Upper Limb & Trauma Surgeon
MBBS (Hons), FRACS, FAOrthA
Thumb collateral ligament repair/reconstruction
The collateral ligaments of the thumb can be injured most often during sport when the thumb is jerked away from the fingers during a fall or from an unexpected force such as a ball, bat, racket or fellow player. When the ulnar collateral ligament is injured, it is commonly referred to “gamekeeper’s thumb” or “skier’s thumb”. Ulnar or radial collateral ligament injuries can causes instability and swelling around the thumb’s metacarpal joint.
Treatment depends on a number of factors:
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How severely the ligament is injured (ie is it a partial tear, large avulsion, complete tear or Stener lesion);
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Whether it is a radial collateral or ulnar collateral ligament injury
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Timing of presentation to a specialist (eg if the patient has a complete tear and waits more than a few weeks post injury to see a specialist, then a direct repair might not be suitable, and the patient may need a reconstruction).
With delayed presentation, the surgery would likely involve reconstruction of the ligament using a slip of a tendon from the wrist (commonly the palmaris longus).
ulnar collateral ligament injury of the thumb, with pure ligamentous injury (left) and bony avulsion injury (right)
Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)
On the day of surgery fingers might feel numb or tingly. This is due to the anaesthetic. Patients can attempt to move their fingers, the tip of their thumb and wrist (if able) before leaving hospital.
After surgery, the forearm and hand will be bandaged and in a plaster cast. These should NOT be removed. The bandage should be kept clean and dry.
To minimise swelling, hands should be lifted to shoulder level.
One week post surgery:
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At this stage a hand therapist will remove the post-operative dressing and place a custom-made thermoplastic splint that includes your thumb over the hand. This splint will remain full time for about four weeks following the surgery.
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The hand, with the thumb well-protected within the splint, can be used for light daily-living activities such as eating, writing, typing and getting dressed. Heavy lifting, gardening or carrying items with the injured hand should be avoided.
4 weeks after surgery:
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The splint can be removed for basic hand hygiene and light thumb movements (actives only). These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement.
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At this stage, patients should be advised to wear your splint part-time. For example, it can be removed when performing sedentary tasks (such as sitting down at the computer / watching TV).
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At this point, scar massage will commence.
6 weeks after surgery:
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Further wean out of the splint will occur. Depending on the degree of stability and stiffness, the splint might only be required when out and about.
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If softer splints were utilised prior to surgery, these should be taken to a hand therapist to assess whether they can replace thermoplastic splint. Softer splints are safe for active tasks at this stage
Between 8-12 weeks after surgery:
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Cease all splints
Driving after surgery
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A car must be able to be safely controlled, including in an emergency situation, before it is safe to resume drive.
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This generally occurs around the 4-to-6 week post-surgery mark, when the thermoplastic splint has been removed. Please do not drive until advised by Kemble or a hand therapist that it is safe to do so.
Return to sports:
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Sport can be resumed at three months post-surgery.
Possible Complications
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Altered sensation around the incision site and along the thumb
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Joint stiffness
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Persistent instability
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Arthritis of the thumb joint
Example of a thermoplastic splint used following collateral ligament surgery of the thumb with Kemble