An Athlete’s Guide to Gamekeepers Thumb

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An Athlete’s Guide to Gamekeepers Thumb

What is Gamekeepers Thumb?

It’s a sprain (small partial tear) or complete rupture of the ulnar collateral ligament (UCL) in your thumb. This ligament helps provide stability to your thumb. The UCL is attached to the middle joint of your thumb (next to the web space of your thumb). This joint is referred to as the MCP joint or metacarpo-phalangeal joint.

The term comes from turn of the century England. At that time, English country estates were kept by simple countrymen called “gamekeepers”. The masters of the estates hunted and feasted on deer and pheasant while the “keepers” survived on rabbits they raised. The “keepers” would often injure the UCL in their thumbs when handling the rabbits. The force would cause the UCL to rupture…hence the name “Gamekeepers Thumb”.

How does Gamekeepers Thumb occur?

Any hard force that pulls your thumb away from your hand can damage the ulnar collateral ligament. Usually the thumb is forced backwards and upwards. It’s a common injury in football players, skiers, and hockey players. One common mechanism of injury is when a football player catches his thumb on an opponent’s jersey or falls on an outstretched thumb.

Skiers and Hockey players often sustain this injury when falling with poles or sticks in their hands. Their thumb gets caught against the pole/stick which forces the thumb backwards and upwards. This is why Gamekeepers Thumb is often referred to as Skiers Thumb.

What symptoms should I look for?

It is common have pain and swelling at inside of the thumb at the MCP joint where your thumb meets the web space of your hand. That area will be tender to the touch. You will notice pain and weakness with pinching activities. Squeezing or holding an item between your thumb and index finger is painful and difficult.

How does my doctor diagnose Gamekeepers Thumb?

Stability of your MCP joint should always be checked by an orthopedic physician. An injury to your ulnar collateral ligament (UCL) causes the MCP joint to become unstable and “loose”. Your ligament either sprains (partially tears) or avulses (ruptures). The other possibility is a piece of bone pulls off with the ligament attached to it. This is referred to as an avulsion fracture. Whichever way it occurs, your MCP joint will be unstable.

You can also try the simple test of squeezing a piece of paper between your thumb and index finger. Try to pull on the paper. Does it cause pain? Are you unable to keep the paper between your thumb and index finger? If your answer is yes to either question then you likely injured your ulnar collateral ligament.

An X-ray must also be done to evaluate the bones of the thumb and hand for a possible avulsion fracture.

How do I treat Gamekeepers Thumb?

The main goal of treatment is to regain stability of your thumb. It’s an absolute necessity for sports performance as well as your normal daily activities.

If your sprain is minor, then icing and taping the thumb for 2-3 weeks is generally sufficient treatment. For more severe sprains or tears, your thumb is splinted or casted for 3-6 weeks or until your thumb is pain free. The cast generally used is a thumb spica cast. A thumb spica cast immobilizes the wrist as well as the thumb.

After the splint or cast is removed, you will need to do range of motion and grip strengthening exercises. Your return to sports participation should also include wearing a protective splint or thumb spica taping.

If you completely rupture your UCL, then surgery is necessary to completely reattach the ligament…since it cannot reattach on its own. Surgery will allow you to regain normal stability of your thumb. This surgery will require casting or bracing and rehab following the procedure. It can take up to 3 months to return to your normal activities after surgical repair.

What happens if I don’t treat Gamekeepers Thumb?

You may permanently lose a large portion of your pinch or grip strength. This affects your ability to do your normal daily activities as well as your performance in sports. Once you loose your strength, it is very difficult to regain it.

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