Gamekeeper’s Thumb

AKA: Skier’s Thumb, Break-dancer’s Thumb

 

• Chronic injury to ulnar collateral ligament (UCL) of thumb first seen in gamekeepers in Scotland
  • Because of the method they used to kill rabbits
• Acute injury now more common amongst skiers
  • Called "Skier's thumb”
    • Due to fall on fall on outstretched hand with abducted thumb caught in pole strap
    • May comprise up to 50% of injuries to hand in skiers
• May also be seen in rheumatoid arthritis
• Injury results in disruption of the ulnar collateral ligament at its site of insertion on the metacarpal-phalangeal joint of thumb
  • UCL is short ligament that originates from the metacarpal head and inserts into medial aspect and base of proximal phalanx of thumb
• Often associated with a fracture of the base of the proximal phalanx

Gamekeeper's or Skier's Thumb: fracture of base of
proximal phalanx of thumb from tear of ulnar collateral ligament

• Torn end of ulnar collateral ligament can be displaced to the abductor pollicis aponeurosis
  • Called Stener lesion
    • Distal portion of ligament retracts and points superficially and proximally
    • Rupture of both the proper and accessory collateral ligaments must occur for this to happen
    • Produces a lump over medial aspect of the MCP joint of thumb
• Full evaluation requires abduction stress views
  • Increase of more than 30° in angle between 1^st metacarpal and proximal phalanx
    • Indicates subluxation
• Treatment
  • Complete ruptures of the UCL require surgical intervention for repair within the first 3 weeks of the injury
    • Best done in 1st week while the anatomy is maintained
    • Complete tears repaired after 3 weeks have increased incidence of weakness and pain on pinch grasp.
  • Increased incidence of MCP joint arthritis has been noted in the long term