Dislocations and collateral ligament injuries to the first metacarpophalangeal joint are important complications of trauma that can be easily overlooked. A sudden valgus stress applied to the metacarpophalangeal joint of the thumb may cause a disruption of the ulnar collateral ligament and often is associated with a fracture of the proximal phalanx. This injury if left untreated may result in every degenerative joint disease of the first metacarpophalangeal joint.
The typical history involves a patient who injures his thumb on the ski slopes. The patient may or may not remember a specific event. Physical examination will usually demonstrate instability in the first metacarpophalangeal joint if the patient is examined before much swelling has occurred. Initial radiographs may be negative, although small avulsed fragments from the base of the proximal phalanx can be delineated in some instances. These fragments may be displaced proximally and rotated from 45 degrees. Radiographs obtained with radial stress applied to the first metacarpophalangeal joint can reveal the luxation of the joint.
It is important to stabilize this joint in order to prevent instability. This injury may take several months to heal and stress to the joint should be avoided.
Deborah Pate, D.C., DACBR
San Diego, California
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
