For many athletes their hands play an essential role in their sport. Whether they are shooting a basketball, gripping a high bar, or blocking a shot on goal it is crucial that their hands are functioning at their best. Gamekeeper’s thumb is a common thumb injury among goalies, skiers, volleyball players, and other athletes. The thumb joint involved in this injury is called the metacarpal phalangeal joint. It is the joint where the first metacarpal and proximal phalanx of the thumb meet.
This joint is held stable by ligaments on either side called the collateral ligaments. These ligaments keep the thumb from going too far to the left or right. When an athlete sustains a tear to the ulnar collateral ligament this is called Gamekeeper’s thumb. The ulnar collateral ligament is on the pinky side of the thumb and tears when the thumb is forced in the opposite or radial direction. This often involves an avulsion of the bone, meaning a small fleck of bone is pulled off with the ligament. Sometimes, a “Stener” lesion will occur in which the ligament becomes displaced above the adductor aponeurosis and will not heal without surgery.
Most athletes with gamekeeper’s thumb present with a history of some kind of trauma to the thumb, whether that was a fall, blocking a shot, or defending an opponent. They will complain of pain in the thumb and they may notice that there is some instability when they try to grab or reach for things. There may be swelling in the joint and sometimes a palpable bump will be present if they have a Stener lesion.
Our doctors will do a thorough examination of the thumb and hand. Sometimes the tears will be quite obvious on examination. X-rays will likely be done in the office to see if there is an associated avulsion fracture. Often widening may be seen at the location of the tear with stress view x-rays. An MRI is the most definitive way to determine the extent and location of the tear. An MRI allows your doctor to see cross sectional images of the thumb and the surrounding tissues and ligaments. Our doctors will ask that you bring a copy of your MRI to your appointment so they can personally review the images. They will be able to look through the images with you and show you the source of your pain and the extensiveness of your injury.
If the ligament is in good position for healing the patient may start with conservative management which is strict immobilization for 4-6 weeks. This would involve wearing a thumb spica cast or splint. This particular type of cast includes the wrist and goes over the thumb all the way to the tip. The index through pinky fingers are free allowing you to do some light activities of daily living. Once adequate healing has occurred and the cast is removed you will likely start physical or occupational therapy. This will help you regain motion and strength that was lost during the healing process. Your doctor will let you know when it is safe to return to play and at what point you are released to use the thumb without restrictions.
If a collateral ligament fails to heal with conservative management or is displaced (ie Stener lesion) surgical intervention may be necessary. This involves making an incision over the disrupted ligament and repairing the native tissue if able or reconstructing the ligament with a tendon autograft if the tear is chronic or a primary repair is not possible. This may involve using a small suture anchor in the bone to ensure a solid repair.
You will need to be strictly immobilized over the next 4-6 weeks to ensure that the ligament heals. This means that your wrist and thumb will be in a thumb spica cast or splint. Our doctors will closely follow your progress after surgery to ensure that you are doing well, your cast is fitting properly and is changed when necessary.
Once adequate healing has occurred your cast will be removed. At that point, you will begin therapy to regain motion and strength. Your therapist will receive detailed instructions from your doctor as to what you are able to do. Your doctor may ask your therapist to make a custom removable brace for you to wear for rest and comfort. Your doctor will let you know when it is safe to return to your sport and full use of the thumb.
Gamekeeper’s thumb or other hand injuries can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for thumb or hand pain and receive superior care from our doctors and staff.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.