Skier’s thumb? Gamekeeper’s thumb?
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The ulnar collateral ligament is a strong, fibrous band that maintains stability on the inside border at the base of the thumb. The ligament prevents excessive thumb movement away from the hand.
How is it Injured?
Injuries usually occur as a result of a sporting mishap. It is commonly seen in skier’s, footballers and rugby players. The ligament may also be directly damaged as a direct result of a fall or other trauma.
The ligament is typically damaged as the thumb is forced away from the hand stretching or rupturing the UCL.
UCL injuries are commonly referred to as “Skier’s thumb” AND “Gamekeeper’s thumb”
Skier’s thumb refers to an acute injury to the ulnar collateral ligament. This involves significant stress to the ligament which stretches the ligament beyond its normal limit. If the ulnar collateral ligament is stretched far enough it will rupture
Gamekeeper’s thumb refers to chronic injury causing a stretching of the ulnar collateral ligament over time. This is usually due to a lower grade repetitive trauma.
Signs and Symptoms?
- Pain and tenderness over the base of the thumb
- Swelling and or bruising over base of the thumb
- Pain with movement of the affected thumb and difficulty gripping objects
- Instability or catching of the thumb on movement
Treatment?
Treatment is highly varied and dependent on a number of factors.
- Severity/grade of the injury
- How long ago injury occurred
- Patient age
- Physical demands of the patient
- Likely adherence of patient to protocols
If only a partial rupture has occurred patients are either placed in a mild cast or wrist splint (known as thumb spica) for 4 to 6 weeks.
If a complete rupture has occurred or there is gross instability of the thumb surgical intervention is most likely. Surgery is most effective when executed within the first few weeks following injury.
What is the recovery after ulnar collateral ligament repair?
Following surgery, patients will be placed in a cast for four to six weeks to protect the repaired ligament. During this time gentle range of movement exercises will be commenced progressing to stretching and strengthening exercises. Return to sports and full activity usually occurs 3 to 4 months after surgery.
