By: 25 October 2011

Michael A. Baskies, MD, and Steve K. Lee, MD.
Bulletin of the NYU Hospital for Joint Diseases. March 2009. Vol. 67. No. 1. Pp. 68-74.

Previously known as gamekeeper’s thumb, today, it’s more likely to be a sports injury, sometimes referred to as skier’s thumb – jamming the web of the thumb into the ski pole tears the ulnar collateral ligament (UCL).

Partial tears can be treated nonoperatively with conservative care. Complete ruptures of the ulnar collateral ligament often require surgical repair. The surgery can be done on an outpatient basis under a regional or general anesthesia. The authors provide a step-by-step description of the surgical repair from incision to restoration of the anatomy.

Sometimes the ligament can be repaired by reattaching it to the bone. Small avulsion fractures can also be repaired this way with special sutures used to anchor the bone fragment in place. Any damage to the other soft tissues or joint capsule can be repaired at the same time. If the damage is too great to repair the problem, then a tendon graft may be needed to reconstruct the joint. No matter whether it’s a surgical repair or reconstruction, the goal is to return everything to as normal an anatomical orientation as possible. This will ensure a return of normal joint kinematics.

The patient is put in a cast and immobilized for six weeks after surgery. When the cast is taken off, the pins and wires holding everything together can be removed. A hand therapist helps the patient get started with range-of-motion exercises. The therapist progresses the rehab program through strengthening and return to full activities without restrictions. All of this takes at least three months for a safe and effective result.

Studies show that this approach is quite successful. The earlier the repair is made, the better the results. Returning to activities when the thumb is unstable can cause further damage that could have been avoided with early diagnosis and treatment. 90% of the time, the results are good-to-excellent with surgical repair.

In a small number of cases problems can occur following surgery such as a nerve palsy affecting motion, joint stiffness, and chronic instability. There is some evidence that these poor results are more likely when treatment was delayed or the diagnosis was missed. Studies to determine the best surgical technique to use for optimal outcomes are underway.

When the surgery is unsuccessful and joint instability persists, it may be necessary to fuse the joint.