THUMB ULNAR COLLATERAL LIGAMENT INJURY

(Gamekeeper’s or Skier’s Thumb)

Gamekeeper's thumb involves injury to the ulnar collateral ligament, which can cause chronic pain and disability. This injury derives its name from the gamekeepers in Europe who would break the necks of game rabbits with their hands, which sometimes would injure a ligament in the thumb. The injured ligament is called the ulnar collateral ligament of the thumb or UCL for short.

This injury involves stretching and tearing of a ligament at the base of the thumb that enables the hand to grab, grasp, or pinch (such as when holding your keys). Thus, injury to this ligament can be disabling.

Sprains are classified into three grades:

First-degree sprain: ligament is painful but normal length. Average healing time 2 to 6 weeks

Second-degree sprain: ligament is stretched or partially ruptured. Average healing time 8 to 12 weeks

Third-degree sprain: ligament is completely torn and does not function. Average healing time 12 to 16 weeks

This injury is usually caused by stress on the thumb that forces the away from the hand. An example is falling with a ski pole, which pushes the thumb away from the hand and toward the body. This most often occurs when falling onto outstretched hands while holding on to a ski pole or in baseball, when catchers try to catch awkwardly. The risk of injury increases with a previous injury to this ligament, skiing with poles, and contact sports. Complications include: injury to bone, cartilage, or tendon tissues, arthritis, recurrent symptoms, prolonged inability to pinch or grasp.

Diagnosis involves radiographs to rule out bone injury and occasionally numbing of the thumb and injured area with an injection of lidocaine so the doctor can test the stability of the ligament without causing undue pain to the patient.

Symptoms

Pain, tenderness, bruising, swelling, and redness at the base of the thumb, starting at the side of injury, that may progress to the whole thumb and even hand with time, Impaired ability to grasp or hold things soon after injury.

Treatment

Initial treatment consists of rest, ice, compressive bandage and elevation to reduce swelling and discomfort. Casting, splinting, or bracing may be recommended to provide support to the joint for varying lengths of time depending on severity and location of the injury. After immobilization, stretching and strengthening of the injured and weakened joint and surrounding muscles is often necessary. Surgical treatment is indicated if there is a complete rupture of the ligament (3rd degree sprain), or if there is a complication called a Stener lesion which is when the thumb adductor muscle aponeurosis gets stuck between the two torn ends of the injured ligament.

Nonsteroidal anti-inflammatory medications (such as aspirin and ibuprofen) or other minor pain relievers (such as acetaminophen) are often recommended. However, there is some evidence that certain subtypes of NSAIDS can impair ligament healing. Because of this, some experts will prescribe only certain NSAIDS or even simple analgesics like acetaminophen. Some will avoid all NSAIDS when treating a ligament injury. Take medication only as directed by your physician. Contact your physician if any bleeding, stomach upset, black tarry stools, or signs of an allergic reaction occur.

Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 20 minutes 4 times daily.

The initial phase of rest, ice, and elevation usually lasts 72 hours and is followed by a graduated program of stretching and strengthening. It is especially important to concentrate on increasing the endurance of the injured area muscles and supporting muscles to help prevent future injury. One often neglected part of rehabilitation involves re-training proprioception in the injured area. This has also been shown to help reduce the incidence of re-injury.