Gamekeeper's Thumb Follow-up

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

Return to Play

After surgical repair, the MCP joint is immobilized in a cast for 4 weeks. After this period, the cast is removed and replaced with a removable thumb spica splint so that MCP motion can begin. This is continued for 2 weeks; then the splint is removed completely so the MCP joint can be fully mobilized. Unrestricted usage and return to sports can begin at 3 months.

Patients are not recommended to return to sports that may stress the hand before 3 months have passed. Premature return to full activity can stress the repair or reconstruction and cause chronic joint instability, which is then very difficult to treat. Chronic pain and degeneration can then develop at the MCP joint of the thumb.

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Complications

Chronic instability of the MCP joint can occur despite a good surgical repair, especially if motion and return to play are resumed prematurely. This instability is difficult to treat and can lead to arthritic changes in the MCP joint, as well as weak pinch grasp in the long term.

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Prevention

Currently, there are no proven accessories for the prevention of Gamekeeper's thumb injuries. Ski gloves are being designed to protect the thumbs during skiing, but these have not yet been proven effective.

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Prognosis

Early diagnosis of Gamekeeper's thumb injuries is one of the most important factors that determines functional outcome. In thumbs with partial ligament injuries, nonoperative treatment by immobilization will yield a stable, painless thumb with nearly normal motion in most cases. In thumbs with a complete rupture that are treated operatively within 3 weeks of injury, a good to excellent result can be expected in >90% of cases.

Pain and stiffness in the affected thumb can be expected to be mild or absent, and pinch and grip strength should be nearly normal. The rate of return to former activities, including recreational sports, has been reported as high as 96%.

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