What is gamekeeper’s thumb, and what does it take to fix it?

Transcript

Hello, I'm Dr. John Knight. Today I want to talk to you about gamekeeper's thumb. Gamekeeper's thumb is an injury to the ulnar collateral ligament that's on the inside of the knuckle of the thumb. It's a very important stabilizing ligament of the thumb, and this can be usually injured in two ways.

As far as the anatomy of the thumb, this is the first metacarpal, or the thumb metacarpal. This is the proximal phalanx, and this is the ulnar collateral ligament. In this case, most commonly it ruptures in the middle of the ligament, just pops, and there's ligament on both sides of the tear. And then there's less common, where the actual ligament stays attached to the bone and a piece of bone pulls off, in this case the proximal phalanx. So it can usually happen one of two ways.

What are the causes of this? Well, most commonly it's from an impact injury or a torquing injury that pulls the thumb out, such as this snowboarder impaling the thumb against the ground, or frequently happens with ski pole injuries, or any injury where the thumb gets bent outwards causing that ligament to rupture.

So how is this diagnosed? Well, it is first diagnosed with a careful examination by a specialist. And so the first thing is to palpate that area to see if there's tenderness and swelling over that injury, over that ligament, and then to stress the ligament. That may be uncomfortable for the patient. Sometimes a local anesthetic can be administered to see if that joint opens up. But with the MRI nowadays, this really gives a great picture of what's going on with a ligament, so we don't hesitate to get an MRI.

And you can see it's called a Stener lesion in this case, where this black structure that normally would attach here at the base of the proximal phalanx has been torn so badly that it's become trapped underneath a muscle here. And that's called a Stener lesion. That's a significant lesion that we'll talk about, usually ends up needing surgery. But in a less severe case it may show the ligament is just thickened or swollen, which would be a lower grade tear.

So the treatment of this conservatively is first, if there's not a Stener lesion, there's no instability of that joint, is to go with a cast. This fiberglass cast called a thumb spica, it comes out to the last joint on the thumb. You could even get a removable brace. And then in severe cases such as this Stener lesion, you really need to stabilize this joint to allow it to heal adequately. And the overall healing time with the cast or with surgery is about six weeks.

But now there's a new anchor system by Arthrex that involves putting in two anchors, much like putting in a grommet into a sheetrock wall to hold a picture. This has thread that comes out of it and allows us to anchor that ligament back to the bone. But now there's an internal brace or splint that's built into this. It's like a piece of tape, and we double this across the joint. It comes out of this hole and then we put it into a hole here with another anchor.

What this allows, particularly in the elite athlete, is to start moving the thumb right away, really start playing sports much quicker than we used to. We used to have to immobilize you for six weeks and then start therapy for several months too, just to get back into the game. But now with this device you can actually start playing much sooner.

For more information on gamekeeper's thumb or other upper extremity injuries or disorders, please visit our website, handandwristinstitute.com. Thank you.