Skier's/Gamekeeper's Thumb

What is Skier's/Gamekeeper's thumb?

Skier's thumb, also known as Gamekeeper's thumb, is an injury to the ulnar collateral ligament (UCL), which is located in the metacarpophalangeal (MCP) joint where the thumb meets the hand. The purpose of the UCL is to keep the thumb stable in order to pinch objects. An injury to the UCL can be painful and result in a loss of function and pinch strength. Most often, these injuries are caused by accidents or falls.

Skier's thumb got its name because this injury frequently happens during skiing accidents during which a person falls and doesn't let go of the ski pole. The thumb is jerked away from the index finger, stretching or even completely tearing the ulnar collateral ligament.

It is also called Gamekeeper's thumb because it can be the result of a gradual injury due to repetitive trauma to the thumb. Treatment can be more difficult for Gamekeeper's thumb because the gradual thinning of the UCL makes it difficult to reattach when torn.

What are the symptoms of Skier's/Gamekeeper's thumb?

Symptoms of Skier's/Gamekeeper's thumb are easily identified. They include:

  • Pain at base of thumb
  • Swelling at base of thumb
  • Difficulty grabbing objects
  • Difficulty throwing objects
  • Unstable or wobbly thumb at its base
  • Bruising at thumb base

Who is most likely to get Skier's/Gamekeeper's thumb?

Injuries to the thumb UCL can happen to anyone who has an accident during which the thumb is pulled backward or to the side. Athletes who use their hands are more prone to this injury. It is especially common in contact athletes who play football, rugby, and wrestling and have to apply force with their thumb while tackling or grappling.

Midwest Orthopaedics at Rush physicians are among the top orthopedic specialists in the U.S. Drs. Mark Cohen, John Fernandez and Robert Wysocki are physicians at the Midwest Orthopaedics at Rush Hand, Wrist & Elbow Institute who are known for treating hand injuries utilizing state-of-the-art and minimally invasive techniques.

How is Skier's/Gamekeeper's thumb diagnosed?

Since this condition involves damage to soft tissue, physicians at Midwest Orthopaedics at Rush (MOR) Hand, Wrist & Elbow Institute will visually examine the affected area, ask patients how the injury occurred, and review symptoms and pain level. X-ray's will determine if this represents strictly a ligament injury or if a piece of bone has pulled off with the ligament, as this difference guides treatment. Special X-ray's may also be obtained with gentle stress on the ligament to actively test the stability of the MCP joint in many cases.

How is Skier's/Gamekeeper's thumb treated?

An orthopedic surgeon who specializes in hands should be seen as soon as possible after the thumb is injured to ensure the best possible recovery.

Non-surgical Treatment Options

  • Ice to reduce swelling
  • Acetaminophen or ibuprofen to reduce pain
  • Splint or cast

Typically, partial UCL tears require immobilization with a splint or cast for four to six weeks. If the UCL is completely torn, surgery is usually required, due to the unpredictable healing of complete tears.

Surgical Treatment Options

Surgery is usually an outpatient procedure and a patient can go home the same day. During surgery, the nerve in the arm is blocked and numbed, but in some cases a patient may receive general anesthesia. The procedure involves making small incisions through which the ligament or damaged tissue is cleaned and a small suture is used to anchor the ligament to the bone at its original insertion point so it can heal in a proper position. If there is a bone fracture, pins may be inserted to ensure proper alignment and healing. A brace or cast is typically recommended for up to six weeks. Treatments received within a month after the injury occurred have a higher success rate.