Gamekeeper’s Thumb
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What is Gamekeeper’s Thumb?
Gamekeeper’s thumb is an injury to the ulnar collateral ligament (UCL) of the thumb. Some may refer to this as skier’s thumb. The UCL helps keep the metacarpophalangeal joint (MCP) of the thumb stable.
How Does Gamekeeper’s Thumb Happen?
Gamekeeper’s thumb is usually a result of repetitive force in a position where the thumb moves away from the palm and index finger. This movement pattern and force cause stress to the UCL.
Originally, the term was in relation to when Gamekeepers would break the neck of game such as rabbits and chickens. Overtime, the stress would cause injury to the UCL.
In later years similar injuries were common in skiers due to the force of the pole between the thumb and index finger during a fall.
Gamekeeper’s thumb can also occur as a result of a fall or force on the thumb during sports activities.
Signs and Symptoms of Gamekeeper’s Thumb
Acutely, gamekeeper’s thumb often causes pain, swelling, and possible bruising over the area of the UCL.
Instability may be noted during functional activities that require grasping. Pain and/or weakness with gripping, grasping, or pinching may be present.
Gamekeeper’s thumb can result in a partial tear, complete tear, avulsion fracture , and/or a stener lesion. An avulsion fracture occurs when the force causes the tendon to tear and pull a small piece of bone with it.
A stener lesion occurs when fibers of the UCL interpose the adductor pollicis muscle and aponeurosis.
Treatment of Partial Tears of the Thumb UCL
Treatment for Gamekeeper’s thumb that results in a partial tear is often immobilization of the thumb in a hand based orthosis for at least one month.
At re-evaluation if the patient is asymptomatic they will come out of the orthosis for active range of motion exercises. These exercises focus on regaining normal movement of the joint.
They may include flexing and extending the thumb, manipulating small and large pegs, transferring marble or beans, and other similar activities.
Rang of motion exercises may focus on the joint above and below the injury if stiffness developed during immobilization.
The patient should avoid tight pinching and gripping for approximately 3 months from injury, and at that point slowly return to normal activity.
Gamekeeper’s Thumb Complete Tears
Treatment for a complete tear with or without an avulsion fracture and/or Stener lesion often results in surgery. At the post-op visit, the patient is fitted with a custom thumb Spica orthosis.
After a few weeks they may begin active range of motion and active assisted range of motion exercises, shortly followed by passive range of motion exercises, and eventually strengthening.
Active range of motion exercises will be similar to the ones listed above. Active assist exercises are exercises the patient performs with assistance of therapist, other hand, or object.
Passive range of motion exercises are initiated to decrease stiffness and regain mobility needed for functional use of hand. The therapist will passively move the joints for an added stretch.
Strengthening may consist of pinching putty, clothespins, and/or using a hand gripper. The therapist will grade activities and progress strengthening as appropriate. The patient can return to most activities approximately 3 months from surgery.
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Gamekeeper’s thumb can cause significant pain and dysfunction, but JOI can help! To see a Jacksonville Orthopedic Institute Orthopedic Hand Specialist, call (904)JOI -2000. To see a JOI Certified Hand Therapist is 1 of our 12 locations, call (904)858-7045.