Gamekeeper's Thumb Clinical Presentation

Updated: Aug 20, 2018
  • Author: Matthew Hannibal, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

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

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  • 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. [6] 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%. [6]

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Causes

See the list below:

  • 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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