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Gamekeeper's thumb: ulnar collateral ligament injury

¹Northeastern Ohio Universities College of Medicine, Rootstown, USA.

American Family Physician

|April 1, 1996

Summary

Thumb ulnar collateral ligament injuries, often from sports, require differentiating complete tears needing surgery from partial tears treatable with casting. Early diagnosis is key for appropriate management.

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Area of Science:

Orthopedic Surgery
Sports Medicine
Traumatology

Background:

Ulnar collateral ligament (UCL) injuries of the thumb were historically occupational, common in gamekeepers.
Currently, these injuries are predominantly acute and sports-related, affecting athletes in skiing, football, and other disciplines.

Observation:

Distinguishing between complete and partial tears of the UCL is critical for determining treatment pathways.
Radiographic assessment plays a role but has limitations in definitive diagnosis.
Partial tears or uncomplicated avulsion fractures of the proximal phalanx are common presentations.

Findings:

Complete UCL tears necessitate surgical intervention.
Partial ligamentous tears can be effectively managed non-surgically.
Uncomplicated avulsion fractures associated with partial tears also respond well to conservative treatment.

Implications:

Family physicians can manage partial UCL tears and associated avulsion fractures with short-arm thumb spica casting.
Accurate differentiation between tear types ensures appropriate and timely patient care.
This approach can prevent unnecessary surgical procedures for less severe injuries.

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