Skip to Main Content

11-15: Gamekeeper’s Thumb (Skier’s Thumb)

Meghan Breed; Robert Warne Fitch

Clinical Summary

Forced radial deviation (abduction) of the thumb can cause a rupture of the ulnar collateral ligament (UCL) known as “gamekeeper’s” or “skier’s” thumb. The tear usually occurs at the proximal phalanx insertion and can be associated with volar plate and dorsal capsule injury. Pain and swelling are present over the ulnar aspect of the proximal phalanx and thumb metacarpal.

Radiographs may reveal a small avulsion fracture of the proximal phalanx. Abduction stress testing (stabilizing the metacarpal with one hand while applying radial stress on the proximal phalanx) may provide additional clinical information, especially in patients with normal radiographs. Classically, more than 30 to 40 degrees radial angulation indicates complete rupture. Stress testing should be done on both sides in extension and 30 degrees of flexion while feeling for a firm endpoint.

Management and Disposition

Apply a thumb spica splint and provide analgesia. Patients with pincer function weakness, point tenderness at the volar-ulnar aspect of the thumb MCP joint, a bony fragment of greater than 15% of the articular surface, avulsed fragment displacement of greater than 5 mm, or significant angulation on stress testing should prompt hand surgery referral. Complete tears need repair within 1 week. A sprain without instability is commonly treated with thumb spica casting or splinting for 4 to 6 weeks followed by range of motion exercises.

FIGURE 11.47

Gamekeeper’s Thumb. Laxity of 30 to 40 degrees more than the uninjured thumb, measured in neutral and 30 degrees of flexion, is strongly suggestive of a complete ulnar collateral ligament tear. There is no “endpoint” to the radial deviation of the phalanx. (Used with permission from Brunicardi FC, Anderson DK, Billar TR, et al. Schwartz’s Principles of Surgery. 8th ed. New York, NY: McGraw Hill; 2005. © 2005 by McGraw Hill.)

In a patient with Gamekeeper's Thumb, there is a laxity of 30 to 40 degrees, compared with the uninjured thumb. The thumb extends down and away from the hand.
View Full Size||Download Slide (.ppt)

Pearls

  1. Radial collateral ligament rupture can also occur with forced adduction but is uncommon.

  2. Skier’s thumb refers to an acute injury, whereas gamekeeper’s has classically been associated with repetitive trauma.

  3. Thumb MCP joint laxity is highly dysfunctional, painful, and may lead to late arthritis.

  4. Complete UCL tears put patients at risk for developing a Stener lesion, which occurs when the aponeurosis of the adductor pollicis becomes interposed between the ends of the torn ligament and prevents healing. MRI is the gold standard for diagnosis.

FIGURE 11.48

Gamekeeper’s Thumb. Stress x-ray of a thumb with a complete ulnar collateral ligament tear demonstrates marked instability of the ulnar side of the MCP joint and radial deviation of the proximal phalanx. (Used with permission from Brunicardi FC, Anderson DK, Billar TR, et al. Schwartz’s Principles of Surgery. 8th ed. New York, NY: McGraw Hill; 2005. © 2005 by McGraw Hill.)

A stress x-ray reveals Gamekeeper's Thumb. The thumb has turned and is standing at an angle away from its base. The other fingers are curved.
View Full Size||Download Slide (.ppt)

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close