Skier's / Gamekeeper's Thumb
The ulnar collateral ligament of the thumb (first metacarpophalangeal joint) is frequently injured in sporting pursuits, leading to pain and instability in the thumb. The injury is from a force that pushes the thumb away from the fingers, resulting in pain, bruising and swelling in the area. The injury may be due to a single force or may be due to repeated forces.
The radial collateral ligament is on the other side of the thumb. It can tear, but this is not as common as a tear on the ulnar side.
Causes & Symptoms
The injury has a number of names, most commonly "skier's thumb" but also "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” frequently occurs when the thumb sustains a stretching injury as it is forced back by a ski pole during a fall.
Pain and swelling is apparent 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 function remains affected as pinching and grasping relies on the injured thumb ligament and the thumb may feel unstable during these activities. You may have trouble writing, turning a door knob, or holding a drinking glass. Sometimes this may manifest 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 associated hand or thumb fracture. The diagnosis and severity of the injury can be confirmed with ultrasound or an MRI scan.
Simple low-grade injuries to the ligament can potentially be treated with a period of splinting followed by rehabilitation supervised by a hand therapist. Usually complete tears of the ulnar collateral ligament require surgical repair. Even with splinting alone, a complete tear of this ligament can fail to heal.
An acute repair usually involves surgical re-attachment of the ligament back to the bone using bone sutures. A delayed or late repair may require reconstruction of the ligament with some other tissue. 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.
Following surgical treatment, the thumb will require full time splinting for up to eight weeks.
Following mobilisation supervised hand therapy will be required to help regain range of motion and strength.