During gymnastic activities, the wrist is exposed to many different types of stresses, including repetitive motion, high impact loading, axial compression, torsional forces, and distraction in varying degrees of ulnar or radial deviation and hyperextension. Many of these stresses are increased during upper extremity weight-bearing and predispose the wrist to high rates of injury during gymnastics. Distal radius stress injuries are the most common and most documented gymnastic wrist conditions. Other conditions include scaphoid impaction syndrome, dorsal impingement, scaphoid fractures, scaphoid stress reactions/fractures, capitate avascular necrosis, ganglia, carpal instability, triangular fibrocartilage complex tears, ulnar impaction syndrome, and lunotriquetral impingement. It is important to diagnose quickly and accurately the specific injury to initiate expediently the proper treatment and limit the extent of injury. In addition, a gymnast's training regimen should also include elements of injury prevention.
Complete rupture of the ulnar collateral ligament injury of the thumb metacarpophalangeal (MCP) joint can be a debilitating injury resulting in decreased grip and pinch strength. The spectrum of injury to this ligament varies from simple strain to complete rupture of both proper and accessory ligaments. Generally, this is a result of an abduction force transmitted across the thumb MCP joint.Physical examination assists in identification of these injuries and the extent of ligamentous injury. Ecchymoses and pain over the ligament are usually present in the acute injury. Chronic injuries may not be painful. A palpable mass may be present. The valgus stress test across this joint in 30 degrees of flexion provides information on the competency of the proper ligaments, whereas valgus stress in extension assesses the accessory collateral ligaments. This stress test is useful in the acute or chronic setting.Stabilization of the thumb MCP joint in chronic injuries can require reconstruction. We describe an anatomic reconstruction using a tendon graft and a bioabsorbable interference screw.
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