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January 2001 Sprained or "Gamekeeper's" Thumb

by James Willis, M.D., Medical Director of the Department of Orthopedics, The Jewish Hospital, Cincinnati, and orthopedic surgeon specializing in the treatment of hand injuries and disorders with The Freiberg Orthopaedic Group.

An automatic reflex when falling is to break the fall with your hands; however, this can result in injuries to the main thumb ligament.  This ligament stabilizes the thumb joint and provides the ability to pinch and grasp.  This injury is often referred to as "gamekeeper's thumb."

The snow and ice that accompany winter often cause many slips and spills throughout the season. An automatic reflex when falling is to break the fall with your hands; however, this can result in injuries to the main thumb ligament, called the ulnar collateral. This ligament stabilizes the thumb joint (metacarpophalangeal) and provides the ability to pinch and grasp. This injury is often referred to as “gamekeeper’s thumb.” To understand the origin of this term, picture a gamekeeper whose thumb is straining from the pull of his animal’s leash.

This type of sprain to the thumb ligament will cause you to partially or totally lose your ability hold items between your thumb and index finger. The injury may not hurt immediately, but it can cause bruising, tenderness and swelling. If you have these symptoms, please see a doctor right away to avoid long-term weakness, pain and instability.

X-rays, ultrasonography or an MRI will reveal what the joint looks like, and what treatment you will need. Most thumb injuries are partial tears. In this case, your thumb joint can be immobilized for a few weeks with a splint or bandage. After a series of rehabilitation exercises, your thumb will probably function normally again with no further problems. Sometimes, however, this ligament is completely torn and the bone may even be fragmented. In this case, surgery is mandatory to put all the pieces back together properly. When meticulously and promptly performed, surgery should result in no future complications or impairments. It is most important to see your doctor right away in order to obtain full and permanent benefit, should surgery be necessary.

SOURCES: American Academy of Orthopedic Surgeons and selected orthopedic journals