Hand Injuries

Baseball Finger
Brachial Plexus Injuries
Carpal Avascular Necrosis
Flexor / Extensor Tendon Injuries
Nerve Injuries
Proximal Interphalangeal (PIP) Joint Injury
Ulnar Collateral Ligament (UCL) of the Thumb

Ulnar Collateral Ligament (UCL) of the Thumb Injury (Skier's Thumb/Gamekeeper's Thumb)

An Ulnar Collateral Ligament of the Thumb (UCL) Injury, which is also referred to as "Skier's Thumb" and "Gamekeeper's Thumb," weakens the UCL and its ability to secure the bones at the base of the thumb (metacarpophalangeal or MCP joint). As a result, the thumb is unable to extend out very far from the hand.

When it is defined as an acute injury, it more accurately depicts the type of injury for which it acquired the name "Skier's thumb." This type of injury is the result of stress placed on the ulnar collateral ligament from an extreme force (valgus force) - such as that which may be experienced when the thumb is caught in a ski pole during a fall. In this situation the ligament undergoes an exaggerated stretch and often tears as a result. Those suffering from an acute UCL injury will experience pain and swelling over the area of the damaged ligament at the base of the thumb. There is difficulty grasping or holding objects firmly and some instability.

The name "Gamekeeper's Thumb" was acquired by the more chronic pattern, which leads to loosening of the ligament over time. Named after early European gamekeeper's, who killed their game by grasping the animal's head between their thumb and index finger to break its neck. This repeated stress results in loosening over time and more chronic patterns of the injury. Today, tennis players and baseball players are more likely to experience this type of UCL injury.

Risk Factors
Those involved in activities or sports that place the thumb in a vulnerable position or those who subject it to repeated stress are at risk for this type of injury. It is often seen in athletes.

Diagnosis and Treatment
A thorough review of the patient's medical history and assessment of the manner in which the injury was incurred will help determine diagnosis. The symptoms experienced and the location of the pain also play a part in diagnosis. Both a physical examination and X-ray are done to confirm initial assessments and determine the extent of the injury. A valgus stress test is also performed in order to check the strength of the ligament and corresponding stability of the joint.

Treatment depends on the severity of the injury, when the injury occurred and other patient factors. For a incomplete tear a thumb spica cast may be used for approximately four to six weeks in order to stabilize and encourage healing. This may be followed by range of motion exercises to improve grip strength.

In more severe cases involving a complete tear or rupture of the ligament and significant instability, surgery is considered - and generally done as an outpatient procedure several weeks following the injury. Patients usually see results within four weeks following the surgery, regaining thumb strength and function. Occasionally the MCP joint will remain unstable and causes pain during pinching or grasping activities. In order to prevent the eventual development of arthritis, which is caused by this type of chronic instability and looseness of the thumb, other procedures may be considered. Such procedures may include grafting in new tissue in order to reconstruct the ligaments, or arthrodesis in order to fuse the joint.