Injury to the ulnar collateral ligament (UCL) at the metacarpophalangeal joint (MCPJ) of the thumb (Figure 1) is a common injury, especially in skiers. It can lead to chronic instability if not treated appropriately; unfortunately it is commonly misdiagnosed. This injury is also known as 'skier's thumb'1 or 'gamekeeper's thumb',2 names relating to the common injury mechanisms, however, the term gamekeeper's thumb refers to a chronic UCL injury, as originally described by Campbell.2 In relation to skiing, the injury often occurs as a person lands on an outstretched hand while still holding a ski pole, causing forced abduction of the thumb, with or without extension.
Injury to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint
(MCPJ) is a common injury, especially in skiers. It is often misdiagnosed, which can
lead to chronic instability.
This article reviews the current literature on UCL injury of the thumb and describes
the clinical assessment and management.
The UCL of the thumb is often injured as a result of forced abduction of the thumb,
with or without extension. The injury can be identified by pain, swelling and
haematoma along the ulnar border of the first MCPJ as well as pain and laxity on
valgus stress testing. Proper examination involves placing a valgus stress on the
thumb and measuring instability. Initial investigation should involve a plain X-ray,
supplemented by ultrasound or magnetic resonance imaging, where appropriate.
Treatment can be conservative or involve surgical management depending on the
severity of the injury.
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