Ulnar collateral ligament injury (gamekeeper's or skier's thumb)
- Bruce C Anderson, MD
Bruce C Anderson, MD
- Associate Professor of Medicine
- Oregon Health Sciences University
Gamekeeper's thumb (or skier's thumb) derives its name from court gamekeepers who developed chronic degeneration of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint when 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 [1-3]. Thumb injuries are second in frequency only to knee injuries among skiers .
The diagnosis and management of ulnar collateral ligament injury will be reviewed here. Other thumb injuries are discussed separately. (See "Evaluation of the patient with thumb pain".)
MECHANISM OF INJURY
Forced abduction and hyperextension of the metacarpophalangeal (MCP) joint is the usual mechanism for ulnar collateral ligament (UCL) injury [1,2,5-7]. 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 ulnar collateral ligament 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 [1-3,5-7]. 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.
Examination — The diagnosis of UCL injury is confirmed by the following physical examination findings [1-3,5-7]:
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