Skiers Thumb / Gamekeeper’s Thumb
Involved Thumb Anatomy
The ulnar collateral ligament (UCL) stabilises the metacarpophalangeal (MCP) joint of the thumb. It prevents excessive sideways movement during pinching and grasping. Damage to this ligament leads to thumb instability and weakness.
Symptoms / Clinical Presentation
1. Pain at the base of the thumb on the inner side 2 .Swelling and bruising 3. Pain when pinching or gripping 4. Reduced thumb movement and strength 5 .Difficulty with daily activities such as squeezing toothpaste or shampoo, holding cutlery, cutting with a knife, and managing buttons or zips
How it happens
Skiers Thumb commonly occurs when falling onto an outstretched hand with the thumb forced away from the palm. This frequently happens during skiing when holding a ski pole. It is also seen in contact and ball sports such as football, rugby, and hockey, where the thumb may be forcefully bent or caught during impact.
Grades of Injury
1 Grade 1 – Mild sprain with ligament stretching
2 Grade 2 – Partial ligament tear
3 Grade 3 – Complete ligament rupture
4 Grade 4 – Complete tear with Stener lesion
5 Grade 5 – Avulsion fracture where ligament pulls away with bone
Management
Management depends on the severity of the injury. Mild to moderate injuries are treated conservatively, while severe or unstable injuries may require surgery.
Conservative (Non-Surgical) Management
Grade 1 and 2 injuries are usually managed with immobilisation using a thermoplastic thumb splint for 4–6 weeks. Hand therapy focuses on reducing swelling, restoring movement, and gradually strengthening the thumb.
**Surgical Management and Post-Operative Rehabilitation
Surgery is recommended for complete tears, unstable injuries, or Stener lesions. The procedure repairs or reconstructs the ligament. Post-operative rehabilitation includes splinting, guided exercises, and gradual return to functional and sporting activities. **
Outcome and Expected Recovery
With appropriate treatment, most patients recover good thumb stability and strength. Conservative cases often return to normal activity within 6–8 weeks. Following surgery, return to full sport typically occurs between 3–6 months depending on healing and rehabilitation progress.
References
British Society for Surgery of the Hand (BSSH). Thumb Ulnar Collateral Ligament Injuries. Campbell CS. Gamekeeper’s thumb. J Bone Joint Surg. Heyman P, et al. Ulnar collateral ligament injuries of the thumb. Hand Clinics.