BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

The danger in a handshake – An unusual case of ulnar collateral ligament rupture

By Ramity Dey and A.D. green, Department of Orthopaedics, Noble’s Hospital, Douglas, Isle of Man, U.K.
Reprinted with permission from Injury, Int. J. Care Injured, 34 (2003), 535-536

ABSTRACT

Background

Rupture of the ulnar collateral ligaments of the thumb are common athletic injuries (Heyman, Gelberman, Duncan et al., 1993; Ritchie & Mutner, 1999). Originally described in Scottish gamekeepers who sustained the injury by breaking the necks of injured hares, ulnar collateral ligament injury now most often and with increasing frequency occurs in the skiers who fall holding onto ski poles, resulting in the term “skier’s thumb” (Morgan & Davis, 1982). It is also very common among basketball players and in grappling sports like wrestling and the martial arts.

We describe a tear of the ulnar collateral ligament caused by a trivial force and occurring in the unusual and unique situation of a simple handshake.

Case Report
A 47-year-old, previously fit jeweler attended A&E with sudden onset severe pain and swelling of his right thumb. He had been at a meeting and had reached behind a colleague to shake hands with the next person. On clasping hands, he felt a sudden and severe pain in his right thumb. Swelling around the joint set in rapidly and he noticed that the thumb was “pointing away” from his hand. On examination, the thumb was swollen, painful on motion and radially deviated. The point of maximum tenderness was found to be on the ulnar aspect of the thumb metacarpophalangeal joint.

Radiographs showed no fractures, but examination under local anesthetic showed ulnar instability of the same joint.

He underwent an exploration and was found to have complete rupture of the ulnar collateral ligament of the thumb. This was surgically repaired and he was discharged the same day in a cast. After four weeks, a removable cast was applied and mobilization and physiotherapy commenced. At the time of the report, two months following the injury, he had regained satisfactory range of motion of the thumb.

This abstract is a portion of the article which appears in the Winter 2005 issue of BodyCast.  
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