Upper limb soft tissue injury

Question 1

Rupture of ulnar collateral ligament of the the thumb?

Answer 1

• Skier’s/gamekeeper’s thumb
• Partial or complete rupture of the ulnar collateral ligament at the MCP joint of the thumb
• Caused by forced abduction
• Signs: tenderness over ligament with some instability
• If not treated can cause weak pinch grip

Question 2

What are the signs of a tendinous injury of the upper limb?

Answer 2

• Will give impaired active movement but normal passive movement
• Causes significant functional impairment
• History of sharp/penetrating injury

Question 3

What is the presentation of an extensor tendon injury before the wrist?

Answer 3

• Only lose extension at MCP joint
• Intrinsic muscles of the hand can still extend at PIP and DIP
• Shown by finger drooping as hand is held out palm down

Question 4

What is the presentation and management of an extensor tendon injury at the PIP joint?

Answer 4

• Boutonierre deformity (PIP flexion, DIP extension)
• Management: hold finger in extension with splint for 6 weeks

Question 5

What is the presentation of an extensor tendon injury over the DIP joint?

Answer 5

• Mallet finger
• Avulsion injury of the extensor tendon from the base of the terminal phalanx
• Often due to trauma (e.g. ball hitting outstretched finger)

Question 6

What is the presentation of injury to flexor digitorum profundus?

Answer 6

• Loss of flexion of DIP
• FDS still allows flexion of PIP and MCP

Question 7

How do you test for rupture of flexor digitorum profundus?

Answer 7

• Hold finger straight at MCP and PIP and see if patient can bend DIP
• Can’t at all = rupture
• Can but painful = less severe tear