Gamekeeper’s thumb (skier’s thumb) is an injury to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint of the thumb. Mainly caused by repetitive stress on the thumb during routine activities. The term Skier’s thumb is mainly used in a condition when there is an acute, forceful abduction of the thumb.
ANATOMY OF THE UCL (ulnar collateral ligament):
The UCL originates from the metacarpal head and point of insertion is medial aspect and base of the proximal phalanx of the thumb.
EXAMINATION OF THE INJURED THUMB:
The injured thumb should be carefully examined for range of motion, swelling, and tenderness at the ulnar aspect of the metacarpophalangeal joint. A palpable mass at this joint may represent the retracted UCL. Bad prognosis depends on failure to diagnose the injury. A gamekeeper’s injury is a contraindication for stress testing, although sometimes the joint is anesthetize with a drug lidocaine for stress testing.
- Metacarpophalangeal joint dislocation
- Phalangeal fractures
- Rheumatoid arthritis
- Painful base of the thumb
- Painful web space between thumb and index finger
- Swelling at the thumb
- Weak grasping power between thumb and index finger i.e weak pinching
- Tenderness and discoloration in the thumb
Before initiating any treatment, a careful examination of the thumb by an orthopedic specialist is necessary to determine the extent of the injury and the treatment options. NSAID’s (non steroidal anti inflammatory drugs) are mostly recommended to reduce inflammation and pain. In order to immobilize and stabilize the thumb, comfortable splints are worn for few weeks to allow healing. Stabilizers reduces stress on the thumb and prevent further injury. The treatment option for the complete rupture of the ligament is surgery.
Patients should be advised to act carefully with the affected hand just after recovery, to avoid recurrence of the injury. Persistent and recurrent injury also requires surgical treatment.