Learning Radiology xray montage
Gamekeeper's Thumb
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
  • 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 (white arrow). The black arrow points to anormal sesamoid bone.

  • Torn end of ulnar collateral ligament can be displaced to the aDductor 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 1st 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