Finger Collateral Ligament Injury Treatment
For complete collateral ligament ruptures causing joint instability, surgical repair using bone anchors is recommended, while partial injuries without instability should be treated conservatively with splinting and rehabilitation. 1, 2
Initial Assessment and Diagnosis
Obtain radiographs (anteroposterior, lateral, and oblique views) before performing stress testing to rule out fractures. 3 Physical examination should assess for joint laxity and instability through careful stress testing of the affected collateral ligament. 1, 2
- MRI can confirm complete ligament rupture when clinical examination is equivocal, though diagnosis is predominantly clinical based on laxity testing 1, 2
- For thumb metacarpophalangeal (MCP) joint injuries specifically, always obtain radiographs before physical examination to avoid displacing a Stener lesion 3
Treatment Algorithm Based on Injury Severity
Partial Ligament Injuries (Stable Joint)
- Treat conservatively with splinting for 3-6 weeks followed by occupational therapy 4, 5
- Initiate early range of motion exercises after initial immobilization period to prevent stiffness 5
- These injuries typically heal with excellent outcomes without surgery 5
Complete Ligament Ruptures (Unstable Joint)
Surgical repair is recommended for complete ruptures causing joint instability to prevent chronic pain and disability. 1, 4, 2
Surgical Indications:
- Joint instability on stress testing 1, 2
- Complete collateral ligament rupture at the proximal interphalangeal (PIP) joint 4
- Thumb MCP ulnar collateral ligament rupture with instability (gamekeeper's/skier's thumb) 3
- Irreducible dislocations 3
Surgical Technique:
- Direct ligament repair using suture anchors is the preferred method 1, 2
- This technique provides reproducible positive results even in chronic cases (delayed presentation) 2
Expected Outcomes
After Surgical Repair:
- All patients achieve stable joints with complete pain resolution 1, 2
- Mean grip strength recovers to 88.5% of the contralateral hand 2
- Mean range of motion: 77° flexion at MCP joint with near-full extension 2
- Mean DASH disability score of 9.56/100 (excellent functional outcome) 2
- Functional scores show 62.5-84.2% excellent results depending on digit involved 1
Timeline:
- Significant pain improvement from mean VAS 4.8 preoperatively to 0.91 postoperatively 1
- Mean follow-up of 17-40 months demonstrates durable results 1, 2
Critical Management Pitfalls
Avoid treating complete ruptures with instability conservatively, as this leads to chronic pain, weakness, and permanent functional disability. 1, 4
- Do not delay surgical referral for unstable injuries or those with rotational deformity 3
- Refer to hand surgery for: irreducible dislocations, unstable fracture-dislocations, open injuries, and any injury with persistent instability after attempted conservative treatment 4, 3
- Even chronic presentations (delayed diagnosis) benefit from surgical repair, so do not assume surgery is contraindicated in late presentations 2
Rehabilitation Protocol
Initiate functional rehabilitation with motion restoration and strengthening exercises rather than prolonged immobilization after the initial healing period. 6, 5 A comprehensive rehabilitation program is critical to outcome, focusing on restoring range of motion, strength, and addressing risk factors for reinjury. 5