Ligaments are strong fibrous bands of connective tissue, connecting bone to bone. Ligaments provide stability to the joint. Skier’s Thumb and Gamekeeper’s Thumb are both injuries to the Ulnar Collateral Ligament (UCL) of the thumb, with the difference between these being Skier’s Thumb is an acute (sudden) injury of the UCL, while Gamekeeper’s Thumb is a chronic injury of the UCL. An injury to the UCL can cause instability at the metacarpal-phalangeal (MP) joint of the thumb, which can greatly limit gripping and pinching function of the hand.

• Skier’s Thumb- Usually an acute injury of the thumb UCL, resulting from a fall on an outstretched hand with the thumb abducted. It is commonly caused from skiing injuries after a fall on an outstretched hand while holding ski poles, forcibly abducting the thumb.
• Gamekeeper’s Thumb- Usually a chronic or overuse condition, injuring the thumb UCL

• Pain and weakness during grasping and pinching
• Instability of thumb
• Decreased thumb range of motion
• Difficulty with fine motor tasks that require use of the thumb
• Swelling in thumb

• When skiing, release the pole before you fall and fall onto an outstretched hand instead
  Keep thumb on the outside of your steering wheel instead of wrapped around to prevent injury during a motor vehicle accident
• Avoid high contact sports
• Decrease repetitive activities requiring forceful gripping

• The thumb will be tested for laxity in the UCL
• Palpation in various aspects of the thumb to determine what may be causing symptoms
• MRI or Ultrasound are good diagnostic tools to visualize the UCL to determine if it is intact or torn

• Rest, Ice
• Conservative treatment for partial tears includes immobilization for a period of 3-6 weeks
• Occupational/Hand Therapy following immobilization if the thumb feels stable for range of motion and strengthening
• If there is a complete tear or a Stener’s lesion, which will prevent healing of the torn UCL, surgery is necessary to reestablish stability of the thumb
• Following surgery, the thumb is immobilized for 4-6 weeks to allow healing of the repaired ligament and then hand therapy is initiated for scar management, range of motion and strengthening exercises

• Following immobilization after conservative or surgical intervention, hand therapy will focus on modalities for pain control
• Range of motion of thumb, fingers, and wrist, minimizing stress on the UCL
  Edema control techniques to help decrease pain and improve function
• Wrist, grip, and pinch strengthening to improve function in everyday activities