What is Gamekeeper’s thumb:
Chronic Injury to Ulnar collateral ligament (UCL) of the metacarpophalangeal joint (MCP) of the thumb is known as Gamekeeper’s thumb. It is a common type of sport-related injury. Sports like hockey, soccer, basketball, volleyball, handball as well as skiing can lead to gamekeeper’s thumb.
In our previous article, we discuss a similar injury known as skier’s thumb. The gamekeeper’s thumb is a chronic injury due to repetitive use or overuse injury. On the other hand, skier’s thumb is usually an acute type of injury.
Etiology of Gamekeeper’s Thumb:
The usual mechanism of injury is a fall on outstretched hand where the thumb is abducted or moved away from the index finger. This valgus force on the MCP joint can rupture the UCL as well as unstabilize the MCP joint.
The injury to the ligament can tear the ligament partially or completely. The rupture of the ligament can be classified anywhere from grade I to III. The grade I injury is a partial tear whereas grade III is a complete rupture of the ligament.
The term “gamekeeper’s thumb” was first coined in 1955 by Campbell who identified the UCL injuries as an occupational disease in Scottish gamekeepers.
Symptoms of Gamekeeper’s Thumb:
MCP joint of the thumb plays an important role in the gripping and pinching function of the hand. Additionally, UCL is a primary stabilizer of the thumb during a forceful gripping. So injury to the UCL leads to the following symptoms:
- Edema or bruising at the site of injury
- Inability or painful gripping and pinching
- Painful or limited range of motion of the thumb
- Loose MCP joint or instability of the MCP joint on examination.
Diagnosis of Gamekeeper’s thumb:
A physician will review the symptoms, and perform a physical examination of both hands. This will help determine lack of a range of motion as well as ligament laxity in and around the thumb. A patient may need a local anesthetic agent for a physician to perform the full examination due to the severity of the pain.
A physician will order imaging like x rays to look for fractures and dislocation. An MRI or ultrasound is performed to observe the severity of the soft tissue damage.
Treatment approaches for Gamekeeper’s Thumb:
The treatment approaches for gamekeeper’s thumb and skier’s thumb are similar. A physician will prescribe medicine to treat pain and swelling. In minor tear, thumb spica splint is used to immobilize the joint for 3 to 4 weeks. A patient can start gentle physical therapy after 4 weeks. Initially, physical therapy aims to reduce pain and gradually range of motion. A clinician will perform an aggressive range of motion after consulting with the physician regarding the healing, as well as the clinical presentation that he observes during his session.
Surgical interventions are necessary where there is a complete tear of the ligament. Thumb is usually immobilized for 6 to 8 weeks after the surgery. The surgeon will refer the patient to Physical therapy or hand therapy to initiate the range of motion and gentle mobilization of the thumb.
Physical therapy for Gamekeeper’s thumb:
The physical therapy treatment concentrates on restoring the range of motion of the thumb as well as improving the strength. Performing the flexion and abduction are crucial in this case.
Abduction of thumb:
Thumb strengthening exercises:
Once a person is able to perform active range of motion without any symptoms, one can move to strengthen exercises. Below are some examples of strengthening the exercise of the thumb.
Grasp strengthening exercise:
Pinch grasp is crucial after a tear of UCL what happens in skier’s thumb. The exercises concentrating on the improvement of the grasping strength are crucial. Gradual practice and proper strengthening exercise will help a person to be able to perform pain-free daily activities.
Below is the PDF version of the exercises.