The Ulnar Collateral Ligament (UCL) is a band of tissue on the inside of the thumb’s main joint, known as the metacarpophalangeal (MCP) joint. An injury to this ligament, often called Skier’s Thumb or Gamekeeper’s Thumb, destabilizes the joint and severely limits pinch and grip strength. Surgery is required for complete tears, known as Stener lesions, where the torn ligament is displaced and cannot heal naturally, or when the joint is significantly unstable. The overall timeline for recovery is a process measured in months, encompassing the surgery itself, an initial period of immobilization, and an extensive rehabilitation program.
Duration of the Surgical Procedure
The time spent in the operating room for a UCL repair is relatively short compared to the overall recovery period. The procedure itself, which involves reattaching the torn ligament to the bone, typically takes between 45 and 90 minutes. The specific technique used, such as a direct repair with suture anchors or a reconstruction using a tendon graft, can influence the exact surgical time.
A ligament reconstruction, necessary for chronic injuries, generally takes longer than a primary repair because it involves harvesting a tendon graft, often from the patient’s wrist. The total time a patient spends in the surgical suite is longer. Preparation, including the administration of anesthesia—often a combination of local anesthetic and light sedation—and sterile prepping of the hand, adds to the total duration.
Immediate Post-Operative Timeline
The immediate post-operative period focuses entirely on protecting the surgical repair to allow the ligament to heal securely to the bone. This phase typically spans the first four to six weeks following the operation. Immediately after surgery, the thumb is immobilized in a bulky splint or cast to prevent any movement that could compromise the anchor or suture repair.
The first follow-up appointment usually occurs between 10 and 14 days post-surgery, where the dressing is changed and any non-dissolvable sutures are removed. At this point, the patient is often transitioned into a lighter cast or a custom-made, non-removable thumb spica splint that maintains the thumb in a protected position. For the entire initial period, the patient is restricted from any gripping, grasping, or pinching motions with the operative hand, as premature stress can lead to failure of the repair.
The Rehabilitation and Recovery Phase
The active rehabilitation and recovery phase is the longest part of the timeline, beginning once the initial protection period is complete, typically around four to six weeks post-surgery. This phase involves structured physical or occupational therapy (PT/OT) to restore the thumb’s function, which is necessary because prolonged immobilization leads to joint stiffness and muscle weakness. The initial goals of therapy are to regain a pain-free range of motion (ROM) in the thumb’s MCP joint.
Active motion exercises are introduced first to mobilize the joint without placing stress on the healing ligament, followed by passive range of motion exercises around six to seven weeks. Strengthening exercises to improve grip and pinch strength are typically initiated later, around eight weeks post-surgery. The repaired ligament is still biologically vulnerable for up to 12 weeks, so therapy progression is carefully guided by the therapist and surgeon to ensure a gradual increase in load. Significant functional improvement is often observed between six and twelve weeks into this phase.
Expected Return to Activity Milestones
The timeline for returning to specific activities is determined by the stability of the ligament repair and the patient’s progress in regaining strength and range of motion. Low-impact activities, such as driving and light office work, are often possible within a few days to a few weeks after surgery. Using the hand for simple daily tasks, such as eating and typing, is generally permitted with the thumb protected in a splint.
A return to more demanding activities is staged progressively, aligning with the biological healing of the ligament. The use of a hand-based splint is often discontinued for light activities around six weeks, but it is recommended for activities requiring sustained gripping or pinching until about 8 to 12 weeks. High-impact or high-stress activities, including contact sports and heavy manual labor, require the longest clearance time. Full, unrestricted return to all activities, including sports, is commonly achieved around 3 to 6 months post-surgery.