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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Thumb MPJ Ulnar + Radial  Collateral Ligament Injuries

Mechanism of Injury:  Thumb MPJ being pulled into radial or ulnar deviation and/or hyperextension (i.e falling on thumb)

Associated injuries: Thumb MPJ volar plate injury, Proximal phalanx fracture, Stener Lesion

Role of the Ulnar Collateral Ligament 

  • Stability of the thumb MPJ, specifically against MPJ radial deviation

  • The UCL is under stress during many ADLs, especially writing and pinching

Role of the Radial Collateral Ligament 

  • Stability of the thumb MPJ,  specifically against MPJ ulnar deviation.


Bony UCL/RCL Avulsion

  •  Small bony fracture (usually the base of the thumb PP)  where the UCL/RCL inserts on to the bone

  • Bony fragment can be seen x-ray

  • A ULQ specialist can assess the fracture and advise likelihood of fracture healing

Soft Tissue UCL/RCL Injury

  • Ligament injury with no bony involvement

  • Unable to detect with x-ray

  • Assess with UCL/RCL stress test (see below) +/- MRI  (see below)

Assessment in Primary Care


  • UCL Stress Test: Stabilise the 1st metacarpal and radially deviate the MPJ. Assess unaffected side as well

  • RCL Stress Test: Similar to UCL stress test except you ulnarly deviate the MPJ

  • X-ray Imaging (will detect bony avulsion not soft tissue)

  • Reduced pinch strength

  • Oedema localised to the ulnar MPJ or radial MPJ

  • Pain with palpation of the ulnar MPJ or radial MPJ


Indications for Operative Management 

Ulnar Collateral Ligament

  • Compound injuries

  • Displaced bony avulsion

    • The more displaced the fracture, the higher the chance of non-union

  • Larger fractures involving the joint surface

  • Physeal fractures in children

  • Stenar Lesion (see below)


Radial Collateral Ligament

  • Compound Injuries

  • Injuries that extend and involve the volar plate or dorsal capsule that result in static joint subluxation


Stenar Lesion (UCL Injury)

  •  A complete tear of the UCL (avulsion or soft tissue)

  •  The distal end of the UCL slips out of the adductor aponeurosis

  • UCL normally sits under the adductor aponeurosis

  • UCL is unable to heal to its anatomical position

  • Avulsion: the bony fragment can be seen on x-ray. Therefore able to assess as to whether the fracture will heal in its current position

  • Soft Tissue: assess with UCL stress test (see above) + MRI

ULQ specialists are available to see patients and assess the above.

If patients require non-operative management, we are able to directly refer them to hand therapy for protective splinting.

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