Skier s Thumb. Dr. Aleix Vidal Baqueira Beret Medical Center Centro Medico Teknon Barcelona
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1 Skier s Thumb Dr. Aleix Vidal Baqueira Beret Medical Center Centro Medico Teknon Barcelona
2 2.471 Skier s Thumb Injuries seen in Baqueira Beret Medical Center since Snow Sport Injuries (seasons )
3 Upper Extremities Injuries Evolution - UP EX Cont ForArm Fx Sk.Thumb GH dislocat 1992/ / / / / / / / / / / / / / / / / / / / / /14
4 Skier's Thumb / GH Dislocation Evolution Sk.Thumb GH dislocat / / / / / / / / / / / / / / / / / / / / / /14
5 12 Skier s Thumb diagnosis in relative numbers at our M C
6 CONTROVERSIES IN SKIER S THUMB MANGEMENT HOW IT DOES OCCUR? HOW SHOULD BE DIAGNOSED? WHEN SURGERY IS ADVISED?
7 2.500 Speciality Related Injuries Alpine ski Carving ski Snowboard Skiboards Cross country Ski freestyle
8 SKI Most Common Injuries Knee Ligaments 10% 9% 5% 29% 7% Skier's Thumb Wrist Fractures Shoulder Dislocations A-C Dislocations 20% ACL 12% 2% 3% 2% Upper Ext Contusions Lower Ext Contusions Trunk Contusions Head/Face Contusion
9 SNOWBOARD Most Common Injuries Knee Ligaments 13% 4% 10% 2% Skier's Thumb Wrist Fractures 11% 20% Shoulder Dislocations A-C Dislocations 29% 6% ACL Upper Ext Contusions 2% 3% Lower Ext Contusions Trunk Contusions Head/Face Contusion
10 Falls With the Pole in the Hand % With Pole 47,59 42,66 % Without Pole 7,47 % Realted to Snowboard 2,28 % Others
11 Falls With the Pole Strap in the Hand % With Pole Strap 46,96 40,13 % Without Pole Strap 7,47 5,44 % Realted to Snowboard % Others
12 % Of the Injured Thumb 48,97 51,03 % Total Right % Total Left
13 % Of the Injured Thumb 6,16 % Dominant Hand Right 83,78 % Dominant Hand Left
14 CONTROVERSIES IN SKIER S THUMB MANGEMENT HOW IT DOES OCCUR? HOW SHOULD BE DIAGNOSED? WHEN SURGERY IS ADVISED?
15
16 RANGE OF MOTION AT THE M-P JOINT OF THE THUMB (1000 normal thumbs) Flexion º.. (10-100) Extension... 20º (0-90) Abduction-adduction. 10º (0-20) Pronation-supination... 0º Ref: (Coonrad & Goldner. JBJS, 50-A(3): , 1968.)
17 INESTABILITY AT THE M-P- JOINT OF THE THUMB >10º op. thumb Bowers & Hurst.JBJS,59-A(4): ,1977 Van Wetter..Ann Chir Main,5(2): ,1986 >15º op. thumb Miller et al. Hand Clinics,4(1):45-65,1988 INESTABILITY AT THE M-P JOINT OF THE THUMB >30º Posner & Retaillaud... Hand Clinics,8(4): ,1992 >35º Palmer & Louis....JBJS,3(6): ,1978 Louis et al......jbjs,68(9): ,1986 Miller et al..hand Clinics,4(1):45-65,1988 >45º Smith..JBJS,59(1):14-21,1977 Derkash et al...clic Orth Rel Res,216:29-33,1987
18 STRESS X-RAY Bowers et al...jbjs,59-a(4): ,1977 Curtis & Downey... Radiology,148(3): ,1983 Curtis & Downey... Radiology,158(3): ,1986 Van Wetter... Ann Chir Main,5(2): ,1986
19 STRESS X-RAYS WITH THE M-P IN EXTENSION Neviaser et al.jbjs,53-a:1357,1971 Smith. JBJS,59-A:14,1977 Eaton & Dray...In Green: Operative Hand Surgery:p657,1982 Buck & Cols. Orthopaedics,5:444,1982 Miller... Hans Clinics,4(1):53,1988 Posner & Retaillaud.. Hand Cl.,8(4):720,1992 STRESS X-RAYS WITH THE M-P IN FLEXION STRESS X-RAYS WITH THE M-P IN FLEXION AND EXTENSION Stener.. JBJS, 44-B:869, 1962 Eaton... In Tubiana (ed), p.877, 1985 Dray & Eaton.. In Green (ed), p.777, 1988 Maulet & Cols. Ann Chir Main, 8:99, 1989 STRESS X-RAYS WITH THE M-P IN SEMIFLEXION Curtis & Downey... Radiology, 148(3)(55-856),1983 Palmer & Louis... JOHS, 3:542, 1978 Louis & Huebner..JBJS, 68-A(9): , 1986 Melone. Em Med Clin N Am, 3:319,1985 Merle... Ann Chir Main, 6(2):170,1987
20 INCIDENCE OF THE RADIAL COLATERAL LIGAMENT VERSUS ULNAR COLATERAL LIGAMENT 1/3 Coonrad & Goldner... JBJS, 50-A:439, 1968 Frank & Dobyns. Clin orth, 83:102, 1972 Green & Tilly.. JBJS,55-A:1480, 1973 Smith... JBJS, 59-A:14, 1977 Camp et al...johs, 5-A:221, 1980
21 Our experience with Skier s Thumb Collateral Side % Collateral Side 11,17 39,01 % Ulnar Collateral Phalange ,82 % Ulnar Collateral Metacarpal % Radial 0 Ulnar Collateral Phalange (E316) Ulnar Collateral Metacarpal (E317) Radial (e318)
22 CONTROVERSIES IN SKIER S THUMB MANGEMENT HOW IT DOES OCCUR? HOW SHOULD BE DIAGNOSED? WHEN SURGERY IS ADVISED?
23 GRADE I.- Injury Classification mild sprain, no instability GRADE II.- moderate sprain, instability not present or undisplaced fracture in the phalange GRADE III.- severe sprain, instability or suspition of Stener lession or displaced fracture in the phalange
24 Our experience with Skier s Thumb 13,84 % Grade I 31,50 54,65 % Grade II % Grade III
25 Ulnar Colateral Radial Colateral
26 Skier s Thumb: When do we have to get surgically active?
27 The answer is in the anatomy and in the biomechanics
28
29 How do we know the Anatomy and the Biomechanics have been disrupted?
30 There are 2 clinical signs that indicate severe disruption
31 Clinical instability compared to the opposite thumb in Extension - Neutral - Semiflexion & Complete Flexion of the mtcp joint. (Pseudo Lachman Test) Palpation of a stump at the head of metacarpal. (Posner& Retaillaud. Hand Clinics 8(4),1992)
32 Skier s Thumb, groups II or III: Take an x ray
33 30% of patients had an avulsion fracture at the base of the phalange
34
35 Postoperative treatment after Stener s lesion repair: - Immobilization for two weeks - Phisiotherapy, with special attention to the IP joint
36 Summary Incidence of Skier s Thumb remains stable in our medical centre Dominant and Non Dominant hand are equally involved Ulnar colateral ligament is more commonly affected compared to the Radial side (8/1)
37 Summary Diagnosis is based on Clinical Signs and X-ray. Treatment orientation is still Challenging Indications for surgical Treatment are: Suspition of Stener lession Displaced Fracture in the Phalange Feeling of Joint Instability compared to the opposite side
38
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