Educational video describing the condition known as the "Skier's" thumb or "Gamekeeper's" thumb.
The most common way to injure the ulnar collateral ligament of the thumb is to fall on the hand with the thumb stretched out.
The skier’s thumb, also known as the gamekeeper’s thumb , are both similar conditions. Both involve insufficiency of the ulnar collateral ligament of the thumb (UCL).
Skier’s thumb –acute condition
Acquired after a fall or similar abduction injury to the MCP joint of the thumb.
Gamekeeper’s thumb – chronic condition
Develops as a result of repeated episodes of hyperabduction
When the injury occurs, a tear or possible avulsion of the ligament may occur at the site of insertion into the phalanx of the thumb.
Stener lesion
The torn ligament or the avulsion fracture may become entrapped by the aponeurosis of the adductor pollicis muscle. The ruptured ligament or avulsed fragment is less likely to heal without surgical treatment. The stener lesion is present in about 80% of complete ruptures involving the UCL of the thumb.
Injury to the ulnar collateral ligament is characterized by painful swelling and weakness when grasping the thumb. Bruise like discolorations may be present on the skin around the joint.
Diagnosis is usually done by clinical exam and stress views. A local anesthesia should be given when doing the stress views. Ulnar collateral ligament stress test in full extension is the best to test the accessory collateral portion of the UCL.
Ulnar collateral ligament stress test in a flexed position to isolate the proper portion of the ligament. the proper portion of the UCL will usually tear first followed by the accessory portion of the ligament. If the joint is unstable when testing in full extension, then both portions of the ligament are torn.
Significance of angulation in stress views
The angle between the first metacarpal and the proximal phalanx is assessed.
Stress test in extension with abduction of the thumb more than 40 degrees in extension indicates a complete injury.
Compared to the other side of the thumb, a difference of 15 degrees is positive for injury.
Treatment of UCL injuries
Partially torn
Usually heals without surgery, use of thumb spica.
Complete tear
Surgery especially with the presence of stener lesion.
