From the Guidelines
For synovitis of the 1st MCP joint with a sprain of the ulnar collateral ligament, I recommend a comprehensive treatment approach, prioritizing rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours, followed by immobilization with a thumb spica splint and gentle range-of-motion exercises. This approach is based on the most recent evidence from the 2019 EULAR recommendations for the management of hand osteoarthritis 1, which emphasizes the importance of individualized treatment and a combination of non-pharmacological and pharmacological modalities. The use of over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for pain and inflammation for 7-10 days is also supported by the evidence 1. Additionally, exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient, as recommended by the 2019 EULAR guidelines 1. Some key points to consider in the treatment approach include:
- Immobilizing the joint with a thumb spica splint for 3-4 weeks to allow the ligament to heal properly
- Gradually progressing to strengthening exercises after the acute phase
- Considering physical therapy for proper rehabilitation, focusing on thumb mobility, grip strength, and pinch exercises
- Possibly using a corticosteroid injection (such as methylprednisolone 20-40mg mixed with lidocaine) for persistent synovitis, as suggested by the 2007 EULAR recommendations 1. It is essential to note that complete healing typically takes 6-8 weeks, though severe sprains may require longer recovery periods, and further imaging like MRI may be needed to rule out a complete ligament tear requiring surgical intervention.
From the Research
Synovitis of 1st MCP Joint and Sprain of Ulnar Collateral Ligament of 1st MCP Joint
- Synovitis of the 1st MCP joint and sprain of the ulnar collateral ligament are common hand injuries that can occur together 2.
- The ulnar collateral ligament of the thumb metacarpophalangeal joint is prone to injury, especially in athletes who participate in sports that involve throwing or catching 3.
- The diagnosis of a sprain of the ulnar collateral ligament of the 1st MCP joint is typically made based on physical findings, but radiographs, ultrasonography, or magnetic resonance imaging (MRI) may be necessary in some cases to confirm the diagnosis and assess the severity of the injury 2.
Treatment Options
- Treatment of a sprain of the ulnar collateral ligament of the 1st MCP joint depends on the severity of the injury, with low- to medium-grade partial tears often being treated with rest and a graduated throwing program 4.
- In cases where the joint is unstable or a bony fragment is displaced, surgery may be necessary within 4 weeks after the injury 2.
- For chronic injuries, ligament reconstruction is often the preferred treatment option 2.
- Biologic agents, such as platelet-rich plasma (PRP), have been investigated as a potential treatment for ulnar collateral ligament injuries, but their efficacy is still unclear 5.
Return to Sport
- The rate of return to sport after nonoperative management of elbow ulnar collateral ligament injuries is around 79.7%, with the rate of return to previous level of play being around 77.9% 6.
- The outcome of nonoperative management is influenced by the severity of the injury, with higher-grade injuries having lower return to sport rates 6.
- Proximal tears have a significantly higher return to sport rate compared to distal tears 6.