Skier's / Gamekeeper's Thumb

The most common ligament to be injured in the thumb is the ulnar collateral ligament.


The breaking of the unlar collateral ligament (first metacarpophalangeal joint) is one of the most frequent injuries sustained from sporting activities, and can result in pain and instability in the thumb. This injury is caused by a force that pushes the thumb away from the fingers, developing in pain, bruising and swelling in the area, and can be caused from a single force or maybe due to repeated forces.

The radial collateral ligament is found on the other side of the thumb. It can tear, but this is not as common as a tear on the ulnar side of the thumb.

Causes & Symptoms

The injury is known by a variety of names, most commonly “skier’s thumb” but also known as “gamekeeper’s thumb”, “cyclist’s thumb”, “driver’s thumb” and “footballer’s thumb”, dependent on the activity but the nature is similar in all. For example, in “skier’s thumb”, this arises when the thumb endures a stretching injury as it is forced back by a ski pole during a fall.

Pain and swelling is clear at the base of the thumb with pinch and grasp activities very difficult. The pain and swelling may only last for a week or two but movement can remain affected as pinching and grasping relies on the injured thumb ligament and the thumb may feel unstable during these activities. You may have difficulty writing, turning a door handle, or holding a glass. Sometimes this may become apparent in pain or weakness during these activities.


Your specialist will examine your thumb to assess if there is a ligament injury. X-rays will reveal if there is an related hand or thumb fracture. The diagnosis and severity of the injury can be confirmed with an ultrasound or an MRI scan.

Illustration and photo of thumb ligament injury


Simple low-grade injuries to the ligament can potentially be treated with an episode of splinting followed by rehabilitation supervised by a hand therapist. Usually complete tears of the ulnar collateral ligament can require surgical repair. A complete tear of this ligament can fail to heal, even with just splinting.

An acute repair involves surgical re-attachment of the ligament back to the bone using bone sutures. Reconstruction of the ligament may be required in a delayed or late repair. A new ligament is often reconstructed using another tendon (graft) from the wrist. Occasionally, a temporary wire may be required to help stabilise the joint.


Post-surgery, the thumb will require full time splinting for up to eight weeks.

Supervised hand therapy will be required following mobilisation to help regain range of motion and strength.


Mr Adrian J Carlos

Consultant Orthopaedic Surgeon MB ChB MRCS(Eng) MSc PgD(Orth) FRCS(Tr&Orth)

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