Gamekeeper’s thumb is a painful condition caused by stretching or tearing of the ulnar collateral ligament (UCL) of the thumb, often due to a fall or chronic overuse. Treatment includes rest, icing, and wearing a protective cast, while severe cases may require surgery. The name comes from Scottish gamekeepers who would break animals’ necks with their thumbs, causing chronic damage to the UCL. Diagnosis involves physical examination and MRI, and treatment usually involves immobilization and anti-inflammatory medication. Surgery may be necessary for severe cases.
Gamekeeper’s thumb is a condition in which the ulnar collateral ligament (UCL) of the thumb is stretched or torn, causing pain, swelling, and weakness. The injury is usually due to a sharp force placed on the middle thumb joint and commonly occurs when a person attempts to break a fall with their hand. Chronic overuse of the thumb joint can also lead to damage to the UCL over time. Gamekeeper’s thumb can usually be treated by resting and icing the thumb joint and wearing a protective cast for a few weeks. If you have severe damage or tears, you may need to have surgery to ensure a full recovery.
The name of the wound has a somewhat gruesome origin. A Scottish doctor coined the term in 1955 after several gamekeepers sought treatment for thumb pain. When a gamekeeper needed to bring down a small animal, he would break its neck using the force of his thumb and forefinger. Chronic pressure exerted on the thumb would lead to damage to the UCL and consequent instability in the thumb joint.
Most cases of gamekeeper’s thumb result from acute, rather than chronic, pressure on the joint. A person may try to pick themselves up when they fall by using excessive force on their thumb. The gamekeeper’s thumb is also called the skier’s thumb, as a falling skier may land with his thumb wrapped awkwardly around a ski pole. Regardless of the cause, most people who suffer from UCL injuries experience sharp pain, swelling, and weakness in their thumb and hand.
A doctor can diagnose gamekeeper’s thumb by conducting a thorough physical exam and asking the patient about his or her injury. A magnetic resonance imaging (MRI) can reveal the extent of ligament damage. Your doctor may also take an X-ray to check for damage to the underlying bone tissue before determining the best course of treatment.
Most cases of gamekeeper’s thumb can be treated without surgery. Patients are usually instructed to rest and cool the joint and to avoid using their thumbs as much as possible. A doctor may decide to fit a patient with a thumb splint or cast to immobilize the bones and allow the joint to heal. Prescription or over-the-counter anti-inflammatory medications can help reduce swelling and sharp pain.
Surgery is typically needed if the UCL is severely torn. During an outpatient procedure, your surgeon may make a small incision in your thumb joint and repair the ligament. After surgery, a patient usually needs to wear a specialized cast for several months to promote healing. Doctors can help a patient engage in strengthening exercises after the cast has been removed to regain flexibility and full use of the thumb.
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