Gamekeeper’s thumb is an injury affecting the thumb. This condition, also known as Skier’s thumb, involves damage to a ligament located at the base of the thumb. It can significantly impact the stability and function of the thumb, hindering everyday activities that rely on pinching or gripping.
Understanding Gamekeeper’s Thumb
Gamekeeper’s thumb involves the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal (MCP) joint. This ligament, a band of tissue on the inner side of the thumb, connects the thumb bone to the hand. Its primary function is to stabilize the thumb, particularly during pinching or gripping. When injured, it leads to instability in the thumb joint.
The name “Gamekeeper’s thumb” originated from Scottish gamekeepers who frequently injured this ligament through repetitive motion, such as breaking the necks of small game. Today, “Skier’s thumb” is often used interchangeably, referring to acute injuries of the same ligament, commonly seen in skiers who fall while holding ski poles. The injury can range from a stretch to a partial or complete tear of the UCL.
Causes and Symptoms
Gamekeeper’s thumb results from a sudden, forceful outward bending or hyperextension of the thumb, known as abduction. Common scenarios include falling onto an outstretched hand, especially when holding an object like a ski pole. It is prevalent in various sports, such as skiing, snowboarding, football, basketball, and hockey, where direct trauma or forceful movements can strain the thumb. Repetitive stress over time can also lead to this condition.
Symptoms often include pain and tenderness at the base of the thumb, particularly on the inner side, near the web space between the thumb and index finger. Swelling and bruising around the thumb joint are also observed. A noticeable weakness when attempting to pinch or grip objects, along with a feeling of instability or looseness in the thumb joint, indicates a potential UCL injury.
Diagnosis and Treatment Approaches
Diagnosing Gamekeeper’s thumb begins with a physical examination by a healthcare professional, who assesses the thumb for swelling, bruising, and tenderness. The examination involves stability tests of the thumb joint, such as the valgus stress test. During this test, the thumb is gently manipulated to check the UCL’s integrity; increased laxity or a lack of a firm endpoint compared to the uninjured thumb can indicate a tear.
To confirm the diagnosis and determine the injury’s extent, imaging studies may be used. X-rays are often taken to rule out associated bone fractures, such as an avulsion fracture where a small piece of bone is pulled away by the ligament. Magnetic resonance imaging (MRI) or ultrasound can provide detailed views of soft tissues, helping to assess whether the UCL is partially or completely torn and to identify any ligament displacement.
Treatment approaches for Gamekeeper’s thumb vary based on injury severity. For partial tears or mild sprains, conservative management is recommended. This involves rest, applying ice to reduce swelling, compression, elevation of the hand, and immobilizing the thumb with a splint or cast for several weeks. For complete UCL tears or cases with chronic instability, surgical repair is necessary. The goal of treatment, whether conservative or surgical, is to restore stability and function to the thumb, followed by physical therapy to regain strength and range of motion.