MANUAL MINORS
Gamekeeper’s thumb is a chronic or acute injury to the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb, caused by excessive and repetitive abduction or direct trauma, such as a fall.
This injury compromises the stability of the thumb, affecting its ability to perform pinching motions. It is common among athletes (skiers) and may present as a chronic condition or an acute injury following trauma.
Diagnosis
Diagnosis is based on trauma history and symptoms such as pain on the inner side of the thumb, swelling, joint instability, and difficulty with pinching movements. The “fan sign” (abnormal thumb abduction) is often present. X-rays help rule out avulsion fractures, while ultrasound or MRI can assess ligament damage.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Simple thumb sprain | Pain without significant UCL damage or severe instability. |
Bennett fracture-dislocation | Intra-articular fracture at the base of the first metacarpal with joint displacement. |
Tendon rupture | Difficulty extending or flexing the thumb without signs of joint instability. |
Thumb dislocation | Obvious displacement of the MCP or IP joint without UCL injury. |
Emergency Management
Immediate immobilisation of the affected thumb with a thumb spica splint or cast to prevent further ligament damage.
Ice application to reduce swelling and analgesics for pain control.
Referral to a hand specialist for definitive evaluation, particularly if a complete ligament rupture or avulsion fracture is suspected.
Definitive Treatment
Partial UCL injuries can be treated with immobilisation in a splint or cast for 4-6 weeks. Complete ruptures or avulsion fractures require surgical repair of the ligament or fixation of the bone fragment. Afterward, rehabilitation with physiotherapy is essential to restore thumb mobility, stability, and function.
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