Gamekeeper's Thumb Clinical Presentation

  • Author: Matthew Hannibal, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 17, 2010
 

History

The gamekeeper's thumb injury may be caused by a valgus stress of any kind to the thumb. The most common history is a fall onto an outstretched arm with an abducted thumb. This commonly occurs in skiers with a ski pole in the hand, which prevents adduction of the thumb when the skier falls.

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Physical

  • The contralateral, unaffected thumb should be evaluated first for ROM and valgus stability in both extension and 30° of flexion. Then, evaluate the injured thumb for swelling and pain at the ulnar aspect of the MCP joint. Ecchymosis is frequently seen.
    • Malik et al suggested comparison with the uninjured contralateral thumb may be unreliable in many individuals and recommended that the lack of a definite end point on stress examination to indicate a complete rupture of the ulnar collateral ligament.[4] When the investigators assessed 200 thumbs of 100 unaffected individuals in extension and 30º of flexion, 34% of subjects showed a difference of 10º or more between the contralateral thumbs in extension; another 12% of subjects showed at least a 15º difference between thumbs. When the thumbs were examined in flexion, a difference of 10º or more was noted in 22% of the thumbs, and a 15 º difference was found in 3%.[4]
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Causes

  • Skiing with poles
  • Falling onto an outstretched arm with the thumb abducted
  • Valgus-producing force on the thumb MCP joint
  • Generalized ligamentous laxity
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Contributor Information and Disclosures
Author

Matthew Hannibal, MD  Staff Physician, Carolina Orthopedic Specialists

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Roger, MD  Director of Hand Surgery, Wyckoff Heights Medical Center; Former Assistant Professor, Department of Orthopedics, Catholic Medical Center of Brooklyn and Queens, New York Medical College

Daniel Roger, MD is a member of the following medical societies: Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br. Feb 1955;37-B(1):148-9. [Medline]. [Full Text].

  2. Newland CC. Gamekeeper's thumb. Orthop Clin North Am. Jan 1992;23(1):41-8. [Medline].

  3. Bekler H, Gokce A, Beyzadeoglu T. Avulsion fractures from the base of phalanges of the fingers. Tech Hand Up Extrem Surg. Sep 2006;10(3):157-61. [Medline].

  4. Malik AK, Morris T, Chou D, Sorene E, Taylor E. Clinical testing of ulnar collateral ligament injuries of the thumb. J Hand Surg Eur Vol. Jun 2009;34(3):363-6. [Medline].

  5. Heyman P. Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. Jul 1997;5(4):224-9. [Medline].

  6. Baskies MA, Tuckman D, Paksima N, Posner MA. A new technique for reconstruction of the ulnar collateral ligament of the thumb. Am J Sports Med. Aug 2007;35(8):1321-5. [Medline].

  7. Shinohara T, Horii E, Majima M, et al. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound. Feb 2007;35(2):73-7. [Medline].

  8. Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. Jul 2006;25(3):527-42, vii-viii. [Medline].

  9. Pichora DR, McMurtry RY, Bell MJ. Gamekeepers thumb: a prospective study of functional bracing. J Hand Surg [Am]. May 1989;14(3):567-73. [Medline].

  10. Sollerman C, Abrahamsson SO, Lundborg G, Adalbert K. Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 cases. Acta Orthop Scand. Dec 1991;62(6):524-6. [Medline].

  11. Maheshwari R, Sharma H, Duncan RD. Metacarpophalangeal joint dislocation of the thumb in children. J Bone Joint Surg Br. Feb 2007;89(2):227-9. [Medline].

  12. Abrahamsson SO, Sollerman C, Lundborg G, Larsson J, Egund N. Diagnosis of displaced ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. May 1990;15(3):457-60. [Medline].

  13. Gerber C, Senn E, Matter P. Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint. Am J Sports Med. May-Jun 1981;9(3):171-7. [Medline].

  14. Michaud EJ, Flinn S, Seitz WH Jr. Treatment of grade III thumb metacarpophalangeal ulnar collateral ligament injuries with early controlled motion using a hinged splint. J Hand Ther. Jan-Mar 2010;23(1):77-82. [Medline].

  15. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. Mar 2010;20(2):106-12. [Medline].

  16. Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg [Br]. July 1962;44:869-79. [Full Text].

 
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Lateral radiograph displaying a gamekeeper's fracture.
Anteroposterior radiograph displaying a gamekeeper's fracture.
Radiographic stress test view of the thumb, showing an ulnar collateral ligament tear.
Ulnar collateral ligament stress test in full extension.
Ulnar collateral ligament stress test in a flexed position to isolate the proper portion of the ligament.
Anterior view of a hand placed in a thumb spica splint.
Lateral view of a hand placed in a thumb spica splint.
 
 
 
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