HWN Suggests

SplintER Series: I Declare a Thumb War

This diagnosis is largely based on clinical history and exam. An X-ray should be obtained to evaluate for an associated avulsion fracture. On exam, valgus stressing of the 1st MCP joint will reveal instability and tenderness on the ulnar aspect of the thumb. Laxity that is greater than 15º difference when compared to the contralateral side suggests UCL injury. The UCL plays a large role in pinch strength.

Test this by having the patient hold onto a piece of paper. If they are unable to hold onto the paper when you try to tear it away, it usually means that they will require surgery.

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Articles of Interest

Skier’s Thumb, more common than you think!

The most common thumb joint injury is called Skier’s Thumb or Gamekeeper’s Thumb. It occurs when the thumb is stretched too far away from the hand accidentally during a fall or playing sport. One of the supporting thumb ligaments is sprained or pulled off the bone with or without a small piece of bone attached. The thumb is usually swollen and painful to move, particularly when stretching it out or pinching and gripping. Often there is no sign of injury on x-ray, however there will be pain and sometimes instability of the joint indicating a ligament injury.

A Real Pain in the Thumb: Your Guide to Gamekeeper’s Thumb

Don’t just sit back and ignore it, as this can lead to a worsening of the condition and possible irreversible damage.

Finger Injuries

Complete tear: Thumb spica with surgical repair within 3 weeks

Gamekeeper’s Thumb and Skier’s Thumb

Instability of MCP joint, and pain and weakness with pincer grasp (tying shoes, tearing paper), extreme pain when catching thumb on objects. Splint: Thumb spica to immobilize.

Hand Emergencies

Assess stability by applying radial stress to the distal thumb while immobilizing the proximal thumb and compare to contralateral thumb.

Hitting the Slopes this Holiday Season? Don’t Get Caught with Skier’s Thumb

The term “Gamekeeper’s thumb” was first coined in 1955 by CS Campbell, who identified UCL injuries as an occupational disease in Scottish gamekeepers. The gamekeepers strangled rabbits using their thumb and index finger, and the repeated valgus stresses resulted in UCL injury and chronic instability of the MCP joint. In the present day, this lesion occurs more frequently in acute sports-related injuries like skiing.

How to Treat Gamekeeper's Thumb or Skier's Thumb

The term Gamekeeper’s Thumb is used when referring to an ulnar collateral injury caused by repetitive stress on the thumb during such activities as using a wrench, twisting electrical cords or wringing out heavy cloths. The term Skier’s Thumb is commonly used when there is an acute, forceful abduction of the thumb as when a skier falls without letting go of the ski pole. The injury may also be the result of falling on an outstretched thumb or catching a ball with an outstretched thumb.

Skier's thumb

Whilst both terms are often used interchangeably, the skier’s thumb refers to the cause as being acute injury. Gamekeeper’s thumb specifically refers to the cause being associated with a chronic injury to the UCL in which it became attenuated through repetitive stress.

The Secret Behind Gamekeeper's Thumb Injury

Gamekeeper’s thumb is really referring to a 'gamekeeper' breaking the necks of animals, primarily rabbits. Wait, what? Our thoughts exactly. The gamekeeper’s thumb injury was started all the way back in the 1950’s. It was first coined by CS Campbell, an orthopedic surgeon, in 1955. He continually observed Scottish gamekeepers and noticed the same injury, damage to the ulnar collateral ligament (UCL).

What's the Diagnosis? Case by Dr. Ryan Spangler

UCL can become torn or avulsed from the insertion on the proximal phalanx; the UCL is an important stabilizer of the thumb; improper management can lead to future disability. Treatment is with a short-arm thumb-spica cast and follow up with a hand surgeon to determine whether management will be conservative or operative.

Resources

StatPearls

The metacarpophalangeal (MCP) joint of the thumb plays an important role in functional hand movements such as gripping and pinching. The radial and ulnar collateral ligaments (UCL) are the primary stabilizers to varus and valgus stress on this joint. Functionally, the UCL is of greater importance because it resists radially directed forces during forceful grasping.