Ulnar collateral ligament injury (gamekeeper's or skier's thumb)
- Matthew Gammons, MD
Matthew Gammons, MD
- Medical Director of Sport Medicine
- Vermont Orthopaedic Clinic
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Gamekeeper's thumb (or skier's thumb) derives its name from court gamekeepers who developed chronic degeneration of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint from repeatedly twisting the necks of fowl and other game caught while hunting. Today, ski pole injuries and other athletic injuries are the most common cause of this condition.
The diagnosis and management of UCL injury of the thumb is reviewed here. Other thumb and hand injuries are discussed separately. (See "Evaluation of the patient with thumb pain" and "Overview of finger, hand, and wrist fractures" and "History and examination of the adult with hand pain" and "Overview of hand infections" and "Scaphoid fractures" and "Overview of carpal fractures".)
Skiing accidents in which the thumb strikes a fixed ski pole and other athletic injuries involving thumb abduction are the most common cause of ulnar collateral ligament tears [1-3]. Complete ruptures are often caused by non-sport-related falls . The injury occurs more commonly in males, with a ratio of 3:2. Thumb injuries are second in frequency only to knee injuries among skiers .
MECHANISM OF INJURY
Forced abduction and hyperextension of the thumb metacarpophalangeal joint is the usual mechanism causing injury of the thumb ulnar collateral ligament (UCL) [1,2,6-8]. This can occur if someone falls onto their thumb or the thumb is struck, violently forcing it into abduction. A similar mechanism occurs when a ski pole becomes fixed in the ground and the momentum of the skier drives the thumb into the pole handle. This usually occurs when a skier falls. Disruption of the UCL may occur from repetitive use as well as acute injury, but this is less common.
Patient presentation — Patients with an ulnar collateral ligament (UCL) injury complain of pain, which is exacerbated by thumb extension or abduction, and swelling along the ulnar aspect of the thumb metacarpophalangeal (MCP) joint [1-3,6-9]. Paradoxically, pain may be minimal when presenting for medical evaluation in patients with a complete UCL tear compared to those with a partial tear. The patient often takes the thumb and first finger and rubs over the MCP joint when describing the condition. If the patient presents several weeks to months after the injury, pain, weakness, or loss of stability are the usual complaints.
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- MECHANISM OF INJURY
- CLINICAL FEATURES
- Patient presentation
- Examination findings
- DIAGNOSTIC IMAGING
- Approach to and methods for imaging
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL AND SURGICAL OUTCOMES
- NONSURGICAL MANAGEMENT
- Acute therapy, splinting, and rehabilitation
- Persistent symptoms
- RETURN TO WORK OR SPORT
- SUMMARY AND RECOMMENDATIONS