Ulnar collateral ligament injury of the thumb

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Ulnar collateral ligament injury of the thumb
Ulnar collateral ligament injury of the thumb
Synonyms	Skier's thumb, Gamekeeper's thumb
Pronounce	N/A
Specialty	Orthopedic surgery
Symptoms	Pain, swelling, instability of the thumb
Complications	Chronic pain, arthritis
Onset	Acute or chronic
Duration	Varies
Types	N/A
Causes	Trauma, repetitive stress
Risks	Skiing, hunting, sports
Diagnosis	Physical examination, X-ray, MRI
Differential diagnosis	Thumb fracture, arthritis
Prevention	N/A
Treatment	Splinting, surgery
Medication	N/A
Prognosis	Generally good with treatment
Frequency	Common in athletes
Deaths	N/A

An ulnar collateral ligament injury of the thumb, also known as "gamekeeper's thumb" or "skier's thumb," is a common injury to the thumb that involves the tearing or stretching of the ulnar collateral ligament (UCL) at the metacarpophalangeal joint. This ligament is crucial for the stability of the thumb, particularly in pinching and gripping activities.

History

The term "gamekeeper's thumb" was first coined in 1955 by Campbell, who observed this injury in Scottish gamekeepers. The injury was caused by the repetitive stress of breaking the necks of small animals, which led to chronic injury of the UCL. In modern times, the injury is more commonly associated with acute trauma, such as falling on an outstretched hand while holding a ski pole, hence the term "skier's thumb."

Anatomy

The ulnar collateral ligament is located on the ulnar side of the thumb's metacarpophalangeal joint. It provides stability to the joint by preventing excessive lateral movement. The ligament can be injured by a forceful abduction of the thumb, which can occur during falls or direct impacts.

Symptoms

Symptoms of an ulnar collateral ligament injury include:

• Pain and tenderness on the ulnar side of the thumb
• Swelling and bruising around the joint
• Weakness in pinching or gripping
• Instability of the thumb joint

Diagnosis

Diagnosis is typically made through a combination of physical examination and imaging studies. The "valgus stress test" is commonly used to assess the stability of the UCL. X-rays may be taken to rule out fractures, and MRI can be used to evaluate the extent of ligament damage.

Treatment

Treatment depends on the severity of the injury:

• Non-surgical treatment: Mild injuries may be treated with immobilization using a thumb splint or cast for 4-6 weeks, followed by physical therapy.
• Surgical treatment: Complete tears or injuries with significant instability often require surgical repair to restore thumb function. Surgery involves reattaching the ligament to the bone or reconstructing it using a tendon graft.

Surgical repair of a gamekeeper's thumb injury

Prognosis

With appropriate treatment, most individuals recover full function of the thumb. However, delayed treatment or improper healing can lead to chronic instability and arthritis.

See also

• Ligament
• Skiing injuries
• Hand injury