Ulnar thumb

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The ulnar collateral ligament is a strong band that is attached to the middle joint of the thumb metacarpophalangeal joint. Injury to this ligament is also known as Gamekeeper's Thumb, because Scottish gamekeepers used to commonly have this type of injury as a result of their jobs; and more commonly today as Skier's Thumb, because it occurs so often in downhill skiing accidents. Injury to this ligament is commonly due to any hard force put on that thumb that causes the thumb to be pulled away from the palm of the hand, usually a result of a sports related injury.

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Description: The ulnar collateral ligament provides stability to the MCP joint of the thumb in flexion and valgus. It originates from the ulnar distal aspect of the first metacarpal and attaches onto the proximal ulnar portion of the proximal phalanx. Injuries to the Ulnar Collateral Ligament can involve a sprain, tear and avulsion.

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A gamekeeper's thumb, also called a skier's thumb, is an injury to one of the important ligaments at the base of the thumb joint. The injury involves the ulnar collateral ligament UCLa band of tough, fibrous tissue that connects the bones at the base of the thumb. This ligament prevents the thumb from pointing too far away from the hand.

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Injury to the ulnar collateral ligament of the thumb is fairly common. This strong band of tissue is attached to the middle joint of the thumb, the joint next to the web space of the thumb. This condition is sometimes called gamekeeper's thumb because Scottish gamekeepers commonly injured their thumbs as a result of their job.

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What are the findings? What is your diagnosis? STIR coronal images through the volar 1a and dorsal 1b aspect of the first metacarpophalangeal joint and STIR axial images at the metacarpal head 1c are provided.

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This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal joint. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead onto to a chronic instability of the thumb which causes problems with function. The injury happens when you fall onto the outstretched thumb see diagram and is more likely if the thumb is gripping something at the same time.

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Ulnar collateral ligament UCL injuries of the thumb sometimes occur with avulsion fracture. Avulsion fractures generally require open reduction and internal fixation to restore stability of the metacarpophalangeal MP joint of the thumb. Although several surgical techniques have been reported, UCL avulsion fractures are still challenging hand injuries to treat and to obtain stable fixation that allows early finger motion because of small size of fragment.

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Common causes include a fall onto an outstretched hand, gripping the steering wheel during a car accident, and falling while holding a ski pole. Symptoms Symptoms typically include pain, swelling, and tenderness on the ulnar side of the thumb MCP joint. Pinching and gripping with the thumb may be difficult, and range of motion may be limited.

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Ulnar collateral ligament injury of the thumb originally derived its name as gamekeepers' thumb from those gamekeepers who would develop the injury as a result of repetitively twisting and breaking of the neck of small game such as birds and rabbits. Any injury causing extreme thumb abduction can result in ulnar collateral ligament injury. In skiers, when the thumb strikes a fixed ski pole there is forced abduction along with hyperextension of the first metacarpophalangeal joint.


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