Gamekeeper’s thumb refers to an injury of the ulnar collateral ligament (UCL), which is found in the thumb. The term “gamekeeper’s thumb” originated back in the 1950’s in the United Kingdom and Scotland when the injury was first seen in gamekeepers, especially rabbit hunters. The injury occurred due to the excess pressure that was placed on the hunter’s thumb by the hand motions that were needed to hunt for small game.
Approximately 200,000 patients per year in the United States are affected by this condition, and it accounts for 86% of all injuries to the base of the thumb.
Gamekeeper’s thumb usually develops due to chronic overuse or injury to the thumb that results in a valgus stress being placed on the joint. In some cases where the UCL is injured acutely, it is referred to as skier’s thumb. Various events can cause gamekeeper’s thumb such as:
- Falling on an outstretched hand
- Repetitive motion of the hand and thumb (i.e. turning a wrench)
- Certain sports where athletes fall on an outstretched thumb or catch a ball with an outstretched hand (i.e. skiing, football, basketball)
Gamekeeper’s thumb can result in various signs and symptoms that make every day activities, such as tying your shoes or drinking a cup of coffee difficult, including:
- Thumb instability
- Thumb weakness and pain
- Tenderness over the affected area
- Swelling and bruising of the thumb
- Decreased range of motion of the thumb
- Inability to grasp/pinch
Gamekeeper’s thumb can be relatively mild or it may be complicated by an avulsion fracture of the proximal phalanx where the UCL inserts, or by a Stenor lesion, which occurs when both the proper collateral ligament and the collateral ligament are ruptured.
Evaluation by your physical therapist will include a thorough history and physical examination and will also include x-rays. The assessment will determine if your injury is a partial tear, complete tear, or avulsion fracture. Typically, incomplete ligament tears are managed with conservative treatment, while patients with complete tears and avulsion fractures are usually managed operatively.
Initial treatment for gamekeeper’s thumb includes rest and immobilization with either a splint or a brace (for 4 to 6 weeks), elevation of the affected hand, ice and hand therapy.
Physical therapists have a variety of therapies to use for the treatment of gamekeeper’s thumb including:
Hands on therapy that includes joint mobilization, soft tissue massage, and deep friction massage. Manual therapy aims to restore range of motion of the hand and thumb.
Stretching to restore normal joint range of motion and strengthening exercises to strengthen your hand and the affected muscles.
Re-training of the upper extremity to restore stability, improve movement and mechanics of the affected upper extremity.
Including electric stimulation, cold laser, ultrasound and others in an effort to decrease pain and inflammation of the affected hand.
Including education on performing daily tasks, as well as stretching, strengthening and stabilization exercises to improve function of the affected hand and thumb.
Once the pain and inflammation are reduced and the joint range of motion and muscle strength are restored, your physical therapist will advise you to gradually return to your normal activities. You’ll also be advised on tips to prevent a reoccurrence of your gamekeeper’s thumb.
It has been found that over 90% patients with gamekeeper’s thumb, that follow a splinting and hand therapy program, have resolution of their symptoms. Usually, patients regain full use of their thumb after 3 months.
In some cases, you may have to undergo surgery for your gamekeeper’s thumb. In these cases, your thumb is placed in a thumb spica cast following surgery for approximately 4 weeks, and is then placed in an immobilizing splint for another two weeks. After this immobilization period, you can begin a physical therapy program to regain your range of motion and improve the strength of your thumb. While recovery rates vary among patients, the majority of patients are able to return to their normal activities approximately 3 months after surgery.
If you think you have gamekeeper’s thumb, consult a physical therapist as soon as possible. Poorer outcomes are typically seen in patients that delay seeking treatment. Consulting one of the physical therapists at Blue Hills Sport & Spine Rehabilitation can help to minimize your pain and improve function so you can get back to your normal activities as quickly as possible.
Read more about Ulnar Collateral Ligament Injuries of the Thumb