A Guide for Patients and Active Individuals
Executive Summary
A UCL injury—often known as Skier’s Thumb or Gamekeeper’s Thumb—occurs when the ligament on the inner side of the thumb MCP joint is overstretched or torn. This ligament is critical for thumb stability and pinch strength. Injuries range from mild sprains to complete tears, some of which prevent natural healing and require surgery. Timely diagnosis, appropriate treatment, and rehabilitation are essential to restore hand function and prevent long-term problems.
Understanding the Anatomy & How It Happens
- The Ulnar Collateral Ligament (UCL) stabilizes the base of the thumb near the palm.
- Injuries usually arise from forceful sideways movement of the thumb—such as falling onto an outstretched hand holding an object (commonly a ski pole) or repetitive overuse.
- The injury can also affect the Radial Collateral Ligament (RCL) on the thumb’s outside edge, though this is less common.
Injury Severity: From Mild to Severe
**Grade 1 (Mild)
- Ligament is overstretched but intact.
- Symptoms: pain, tenderness, some swelling.
**Grade 2 (Moderate)
- Partial tear of the ligament.
- Symptoms: pain, swelling, limited thumb use.
Grade 3 (Severe)
- Complete ligament tear; sometimes the torn part drifts away from the bone (called a Stener lesion).
- Symptoms: unstable thumb, difficulty pinching, visible lump under the skin.
How Your Injury Is Diagnosed
- Medical history and physical exam focus on how it happened and how unstable the thumb feels.
- Imaging tests include:
- X-rays: To rule out bone fractures or avulsion injuries.
- MRI or Ultrasound: To confirm tears and check for Stener lesions.
Treatment Options
Non‑Surgical Care
- Ideal for Grades 1 and 2, and non-displaced Grade 3 tears with stable joints.
- Involves immobilising the thumb for 4–6 weeks using a splint, plus icing, elevation and over‑the‑counter pain relief.
- Well-managed cases often heal fully without surgery.
When Surgery Is Needed
- Required for complete tears with ligament displacement (Stener lesion), or unstable joints.
- Surgical repair reconnects the ligament to its attachment point; more chronic injuries may need tendon reconstruction.
- Excellent success rates with most people regaining strength and motion.
Recovery & Rehabilitation
- Cast and splint care: Initial immobilisation is followed by guided splint use—always keep it clean and dry.
- Therapy starts after a few weeks, focusing on gentle motion and gradual strengthening.
- Return to daily activities is staged:
- Light tasks (e.g. typing) at 6 weeks,
- Medium tasks (e.g. cooking/driving) by 8 weeks,
- Full activities—including sports—by 12 weeks.
- Therapy guided by a hand therapist prevents stiffness and ensures the ligament heals properly.
Possible Challenges to Watch For
- Stiff or weak thumb joints.
- Persistent instability if untreated or under-treated.
- Joint arthritis over time.
- Nerve numbness or skin problems post-surgery (rare).
- Long-term pain or reduced ability to pinch.
Frequently Asked Questions (FAQs)
What types of thumb ligament injuries exist?
Injuries range from mild overstretching (Grade 1) to full tears (Grade 3). Most involve the UCL on the thumb’s inner side.
How do these injuries occur?
Common causes include falls onto the hand, especially during skiing, or repetitive hyper-abduction from gripping motions.
What warning signs suggest surgery is needed?
Persistent instability, a visible bump (indicating a Stener lesion), or a joint that opens more than usual on testing.
How long until I can use my thumb again?
Light use after 6 weeks, moderate use by 8 weeks, and full strength and activity by around 12 weeks—depending on your injury and healing.
How can I minimise my risk in the future?
Use protective gear during sports, warm up properly, release your grip during falls (e.g. let go of ski poles), and avoid repetitive strain motions.
Key Take‑Home Messages
- Don’t delay—early expert assessment is critical for good outcomes.
- Mild injuries may heal without surgery; others need repair.
- Strict splint use and guided rehabilitation are essential.
- Full, stable recovery is very possible when managed correctly.
When to See a Professional
Seek prompt evaluation if:
- You can’t grasp or pinch normally.
- Your thumb feels unstable or appears deformed.
- Swelling and bruising worsen.
- Pain hasn’t improved after a week of rest and splinting.
Disclaimer: This article provides general information and does not replace medical care. For personalized evaluation and treatment, please speak with a certified hand therapist or orthopaedic specialist.