This document discusses gamekeeper's thumb, which is a chronic injury to the ulnar collateral ligament of the thumb metacarpophalangeal joint. It can occur in gamekeepers from forcefully extending animal's necks or in skiers from falls onto an outstretched hand. The injury ranges from partial tears of the ligament to complete ruptures, which may involve an interposed tissue fragment that prevents healing. Treatment involves splinting for partial tears or surgical repair for complete tears, ideally within 3 weeks for best results.

1. Dr. Santosh Batajoo
Resident (Orthopaedic Surgery)

2.  Injury to the metacarpophalangeal joint ulnar
collateral ligament of the thumb.
 A tear or avulsion of the ligament
may occur at the site of insertion
into the phalanx of the thumb.
 Skier’s thumb- acute condition
 Gamekeeper’s thumb – chronic condition – as a
result of repeated episodes.

3.  C S Campbell, an orthopedic surgeon originally
coined the term gamekeeper’s thumb in 1955, after
he observed this condition in a series of Scottish
gamekeepers.

4.  Gamekeeper’s – who kill small animals by
forcefully extending the neck.
 Skiers- who fall onto the extended thumb,
hyperabduction.
 athletes

5.  The capsule is thickened medially and laterally to form
the ulnar and radial collateral ligaments which are static
stabilizer of MCP joint.
 Ligament- proper and accessory
ulnar collateral ligament
 The capsule is thin over its
dorsolateral aspect between EPB and abductor pollicis.
dorsomedial aspect between the EPB and the adductor
pollicis.

6.  Rupture of ulnar collateral ligament caused by
forcible abduction.
 Fall onto an outstretched hand.
 Gamekeeper’s fracture – an avulsion fracture

7. A. Partial rupture – only the ligament proper is torn.
Thumb is unstable in flexion.
B. Complete rupture – Thumb is unstable in all the
positions.

8. The stener lesion – Interposition of the adductor
pollicis aponeurosis between the ends of the torn
ligament.
 Prevent healing of the ligament.
 Chronic instability.
 Present in about 80% of complete
ruptures.

9. type injury treatment
1
2
3
4
5
6
Fracture undisplaced
Fracture displaced
Ligamentous tear, stable
Ligamentous tear,
unstable
Volar lip fracture
Ulnovolar fracture and
ligamentous tear.
Conservative
Surgical
Conservative
Surgical
Conservative
surgical

10.  Swelling and tenderness over the ulnar side of the
thumb metacarpophalangeal joint.
 Bruise like discoloration around the joint.
 Interference in pinching activity, grasp.
 Laxity of the joint
 Lump (stener lesion).

11.  Abduction stress testing
Joint in full extension and 30 degrees of flexion.
Should be compared with the uninjured thumb.
 Stress test in extension with abduction more than 40
degree indicates a complete injury. Compared to
other side- difference of more than 15 degree.

12.  X-ray – To exclude a fracture.
avulsion fracture: fragment from
the base of the proximal phalanx.
Subluxation
Stress view examination
 Minimally displaced (<2mm)
avulsion fracture – complete
avulsion without Stener lesion.
 Ultrasonography
 MRI

13.  Chronic instability
 Arthritic changes in the MCP joint.
 Weak pinch grasp.
 Stiffness of the MCP and IP joints.
 Neurapraxia of the radial sensory nerve.

14.  Partial tear-
Immobilization in a splint for 4-6 weeks followed by
movement.
Thumb spica cast or brace.
 Complete tear-
Operative repair. Immobilized postoperatively for 6
weeks. Flexion extension can be started early.
Interphalangeal joint should be left free.
Unrestricted usage is allowed at 3 months.

15.  Delayed diagnosis – dissecting out the ligament
from within the fibrotic mass and reattaching it.
 Late diagnosed complete tear (several months) -
Repair of the capsulo-ligamentous complex with a
palmaris longus free tendon graft or
MP joint fusion.
 If arthritis is present, arthrodesis of the MCP joint.

16.  Early diagnosis is the important determinant of
functional outcome.
 Complete ruptures that are surgically treated within 3
weeks have good result.
 The prognosis for repairs undertaken longer than 6
weeks is poor.
 Physical therapy after surgery.