Gamekeeper's Thumb | Skier's Thumb
What is it?
Gamekeeper’s thumb (or skier’s thumb) is an insufficiency of the ulnar collateral ligament (UCL) at the joint of the base of the thumb. It was previously very common in game keepers but today athletic injuries are the most common cause of this condition. The ulnar collateral ligament does not heal like other ligaments in the hand. It is crucial however for gripping and so management of it requires great care.
How did I get it?
Ligaments act like ropes to anchor bones together. The UCL is on the inner border of the thumb and stops the thumb from moving outwards. If the thumb is forcefully pulled out to the side the ligament can tear. See figure 1. This can happen if someone falls onto their thumb or the thumb is struck violently forcing it outwards. Disruption of the ulnar collateral ligament may occur from repetitive use as well as acute injury but the former is less common. Due to the position of the ligament a complete tear tends not to heal.
What are the symptoms?
Patients with an ulnar collateral ligament injury complain of pain that is exacerbated by pulling the thumb out to the side. There will be swelling along the inner aspect of the base of the thumb and a loose sensation of the thumb.
What should I do?
If you suspect that you have an ulnar collateral ligament injury it is important to seek medical attention at your earliest convenience. A complete rupture of the tendon will usually not heal. It is important that an appropriate diagnosis is made and proper treatment is started early.
How is a diagnosis made?
A diagnosis is made on the history of the injury and examination findings. X-rays will almost always be ordered to ensure that there is no broken bone. Sometimes the ligament is stronger than the bone and the ligament rather than tearing pulls a piece of bone off. Only occasionally are stress radiographs, ultrasounds and/or MRI ordered. It is very important that the correct diagnosis is made. A complete rupture of the tendon will usually not heal and consideration of surgical intervention should be made.
What does rehab involve?
Non operative management
If there is a small minimally displaced bone fragment or if there are signs of only a partial tear then activity modification, rest and immobilisation is the required treatment. A thumb spica may be used and will allow the bone / ligament to heal. See figure 2 for some of the available supports / thumb spica.
Surgical management
Referral for consideration of surgery is necessary if there is a large bony fragment displaced by more than 2mm or if there are signs of complete ligament rupture e.g. instability, sloppiness or looseness of the thumb. The reason that the ligament does not heal is because another soft tissue gets trapped between the two ends of the torn ligament and prevents them from healing back together.