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Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an injury that rather frequently occurs in certain sports. When diagnosed incorrectly, delay in treatment can ultimately lead to chronic instability and pain. Correct knowledge of the anatomy and method of physical examination is essential when assessing a patient suspected of having skier's thumb. This article describes three different types and treatment of skier's thumb, and further describes the relevant anatomy, correct physical examination, available additional imaging and various treatments possible.

The practice guideline 'Traumatic knee complaints' from the Dutch College of General Practitioners is aimed at differentiating between intra-articular and extra-articular lesions. The diagnosis is based mainly on a combination of patient history and a limited physical examination of the knee. Specific tests for hydrarthrosis, injuries to the collateral or cruciate ligaments, and meniscal pathology have only a low diagnostic accuracy. Few reliable studies have been conducted into the diagnostic value of specific tests; most studies employed poor methodology, had considerable inter-observer variation and produced widely heterogenous results. Inspection of the knee can provide information regarding the presence of fluids in the knee (hydrarthrosis or haemarthrosis). A restricted active range of movement in flexion and extension may indicate osteoarthritis or arthritis.

The practice guideline 'Traumatic knee complaints' from the Dutch College of General Practitioners is aimed at differentiating between intra-articular and extra-articular lesions. The diagnosis is based mainly on a combination of patient history and a limited physical examination of the knee. Specific tests for hydrarthrosis, injuries to the collateral or cruciate ligaments, and meniscal pathology have only a low diagnostic accuracy. Few reliable studies have been conducted into the diagnostic value of specific tests; most studies employed poor methodology, had considerable inter-observer variation and produced widely heterogenous results. Inspection of the knee can provide information regarding the presence of fluids in the knee (hydrarthrosis or haemarthrosis). A restricted active range of movement in flexion and extension may indicate osteoarthritis or arthritis.

Two patients, a 20-year-old male and a 33-year-old female, were referred to our orthopaedic outpatient clinic and presented with habitual anterior (sub)luxation of the shoulder as a result of humeral avulsion of the inferior glenohumeral ligament (HAGL lesion). Both patients underwent an open surgical procedure in which the ruptured ligament was restored and fixed to its anatomical point of insertion. Six months after the operation both patients had regained normal function in the glenohumeral joint without instability. The HAGL lesion is a relatively uncommon cause of anterior shoulder instability and requires surgical intervention. Recognition during physical examination, additional examination and arthroscopy are essential for a good outcome.

Traumatic hyperextension of the carpus in the dog may result in severe lesions of the palmar ligaments, which cannot be treated by coaptation splinting alone. Treatment in three dogs by partial arthrodesis using plate osteosynthesis is discussed.

Patellar tendon ruptures are relatively rare. The rupture may be caused by direct trauma, but is mostly caused by acute or chronic excessive traction force. Degenerative bone/tendon disease may also give rise to rupture. The diagnosis, which usually is not difficult to make, may easily be overlooked when active extension is still possible as may happen in case of a rupture due to an avulsion fracture at the tendon-bone junction. Impaired extension makes operative treatment necessary. Long term follow-up results show excellent function following early repair.

An intra-articular method designed to stabilise the knee joint using synthetic material after rupture of the anterior cruciate ligament is described. The results obtained in forty dogs and two cats treated by this method during the period from 1980 to 1985, are reported. The morbid-anatomical findings within fourteen months after surgery are referred to in one case. Rejection of the ligament was not observed in a single case. When habitual or stationary medial dislocation of the patella was present in addition to a lesion of the anterior cruciate ligament, the patella was no longer found to be subject to dislocation following stabilisation of the knee joint. Clinical results ranged from moderate to satisfactory, varying with the degree of arthrosis and the lesions of the meniscus which were present. This technique does not take up much time and consequently saves expenses.

Retropatellar chondropathy is a frequent cause of pain in the knee; it usually runs a favourable natural course. When the symptoms interfere with work or sports, reduction of pain can be achieved by cleaving the lateral retinaculum (lateral release). To assess the results, a questionnaire was sent to 96 persons; 80 questionnaires could be evaluated. Only patients who had minor or no visible damage of the patellar cartilage were included in this study. Fifty-three patients reported improvement, in spite of which 34 had persistent mild symptoms which forced 12 of them to change the nature of their work. Thirty-seven patients had to change their sports activities in spite of the operation.

A stable metacarpophalangeal joint of the thumb is indispensable for a normal grip function of the hand. The joint is stabilized by collateral ligaments. A rupture of the ulnar, collateral ligament is often caused by a sports trauma, as indicated by the denominations "skiërs duim", "goalkeeper's thumb" and "baseball thumb". Many surgeons are not familiar with the phenomenon of an insufficient collateral ligament, also called "wackeldaum". In the period 1981-1985 a consecutive series of 35 patients with a ruptured ulnar collateral ligament was operated in the De Wever hospital Heerlen (Netherlands). On the basis of our own patients, attention is given to the diagnosis, therapy and results of the operative treatment of these lesions.