A skier falls on an outstretched thumb and develops marked laxity of the thumb metacarpophalangeal joint on valgus stress. A firm tender lump is palpable over the ulnar side of the joint, and stress radiographs show more than 35 degrees of opening. The most appropriate treatment is:
- A Surgical exploration and repair of the ulnar collateral ligament ✓
- B Thumb spica cast immobilisation for six weeks
- C Arthrodesis of the thumb metacarpophalangeal joint
- D Corticosteroid injection followed by mobilisation
Correct answer: A. Surgical exploration and repair of the ulnar collateral ligament
Explanation
The palpable lump represents a Stener lesion, in which the torn ulnar collateral ligament is displaced superficial to the adductor aponeurosis and cannot reunite with its insertion. Because the interposed aponeurosis blocks ligament healing, operative repair is required. Cast immobilisation alone is adequate only for partial tears without significant laxity or a palpable mass. Arthrodesis is a destructive salvage option never used as primary treatment in this setting.
Reference: Green's Operative Hand Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.