A 27-year-old rugby player injures his thumb while tackling. Radiographs show no fracture. There is marked laxity to valgus stress of the thumb metacarpophalangeal joint with no firm endpoint, and a tender firm mass is palpable at the ulnar margin of the joint. Management should be:

• A Thumb spica cast immobilisation alone for six weeks
• B Arthrodesis of the metacarpophalangeal joint
• C Delayed ligament reconstruction after three months of splinting
• D Early operative repair of the ligament ✓

Explanation

Complete rupture of the ulnar collateral ligament with a palpable mass indicates a Stener lesion: the adductor pollicis aponeurosis is interposed between the torn ligament and its insertion, preventing healing. Closed splinting fails because the ligament ends cannot appose. Complete tears without an endpoint, or any tear with a Stener lesion, need early direct repair. Arthrodesis destroys a joint that can otherwise function well after repair.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.