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Gamekeeper's thumb is a condition in which the ulnar collateral ligament (UCL) in the thumb is strained or torn, leading to pain, swelling, and weakness. The injury is usually due to acute force placed on the middle thumb joint, and commonly occurs when a person attempts to break a fall with his or her hand. Chronic overuse of the thumb joint can also lead to UCL damage over time. Gamekeeper's thumb can usually be treated by resting and icing the thumb joint and wearing a protective cast for a few weeks. In the case of severe damage or a tear, an individual may need to undergo surgery to ensure a full recovery.
The name of the injury has a somewhat gruesome origin. A Scottish doctor coined the term in 1955 after several gamekeepers sought treatment for thumb pain. When a gamekeeper needed to put down a small animal, he would break its neck using the force of his thumb and forefinger. The chronic pressure exerted on the thumb would lead to UCL damage and resulting instability in the thumb joint.
Most cases of gamekeeper's thumb result from acute, rather than chronic, pressure on the joint. A person might try to catch him or herself when falling, placing excessive force on the thumb. Gamekeeper's thumb is also called skier's thumb, as a falling skier can land with his or her thumb awkwardly wrapped around a ski pole. Regardless of the cause, most people who suffer UCL injuries experience acute pain, swelling, and weakness in the thumb and hand.
A doctor can diagnose gamekeeper's thumb by conducting a thorough physical examination and asking the patient about his or her injury. A magnetic resonance imaging (MRI) scan can reveal the extent of ligament damage. The physician may also take an x-ray to check for underlying bone tissue damage before determining the best course of treatment.
Most cases of gamekeeper's thumb can be treated without surgery. Patients are usually instructed to rest and ice the joint, and avoid using their thumbs as much as possible. A doctor may decide to fit a patient with a thumb brace or cast to immobilize the bones and allow the joint time to heal. Prescription or over-the-counter anti-inflammatory drugs can help to reduce swelling and acute pain.
Surgery is typically required if the UCL is severely torn. During an outpatient procedure, the surgeon can make a small incision in the thumb joint and mend the ligamen. Following surgery, a patient usually needs to wear a specialized cast for several months to promote healing. Doctors can help a patient engage in strengthening exercises after the cast is removed to regain flexibility and full use of the thumb.