Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of ulnar-sided thumb pain and swelling following a forced radial abduction injury (e.g., fall onto outstretched hand or ski pole injury). Reports difficulty with pinch-grip tasks and localized tenderness at the MCP joint. No history of prior instability or chronic ligamentous laxity.
Clinical Examination Findings
Physical exam reveals localized edema and ecchymosis over the ulnar aspect of the thumb MCP joint. Tenderness to palpation at the ulnar collateral ligament (UCL) insertion site. Stress testing demonstrates increased laxity compared to the contralateral side in both full extension and 30 degrees of flexion. Assessment of the Stener lesion (palpable mass) is noted. Neurovascular status is intact distally.
Treatment Protocol
Immobilization in a thumb spica splint or cast for 4-6 weeks to allow ligamentous healing. If complete rupture or Stener lesion is suspected, surgical referral for UCL repair or reconstruction is indicated. NSAIDs for pain management and edema control. Transition to supervised physical therapy for range of motion and strengthening once stable.