ulnar collateral ligament tear; gamekeeper's thumb; skier's thumb

Etiology

• acute traumatic injury
  • fall on outstretched hand
  • automobile accident
• chronic injury
  • rheumatoid arthritis

Pathology

• gamekeeper's fracture
  • avulsion of the bony ligamentous attachment point at the base of the proximal phalanx

Physical examination

• after fracture has been excluded the thumb may be manipulated to evaluate injury to the ulnar collateral ligament

Radiology

• radiographs of the hand
  • valgus stress radiographs can help identify tendon injuries
    • digital block prior to stress radiographs
• ultrasonography if the diagnosis is in question
• magnetic resonance imaging if ultrasonography is not diagnostic or if details regarding the extent of the tear are not apparent

Management

• complete tears require hand surgery
• incomplete tears can be managed conservatively with immobilization of the thumb a spica cast for 4 weeks

More general terms

• wrist injury
• ligament tear

Additional terms

• ulnar collateral ligament (UCL)