Gamekeeper’s Thumb

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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 patient attempts to break a fall with his / her hand. Chronic overuse of the thumb joint can also lead to UCL damage over a period of time. Gamekeeper’s thumb can normally 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. Most cases of Gamekeeper’s thumb result from acute, rather than chronic, pressure on the joint. A person might try to catchy 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 Gamekeeper’s thumb injuries experience acute pain, swelling, and weakness in the thumb and hand.

Causes & Symptoms

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Generally, Gamekeeper’s thumb injuries occur when the thumb bends away from the metacarpal-phalangeal (MCP) joint in an unnatural fashion. There are typically three different versions of thumb UCL injuries with different causes:

 

  • Acute injuries – External force or trauma forces the thumb to bend away from the hand. This can occur as a result of falling, for example whilst skiing (hence the name Skier’s thumb).

 

  • Chronic injuries – Repeated stretching of the thumb extends the UCL beyond reasonable ranges of motion. This can occur as a result of tending to hunting games (hence the better known name for the injury of “Gamekeeper’s thumb”).

 

  • Stener lesions – A complete tear of the UCL forces the ligament out of position and traps it between the thumb muscles and bone. This is a serious complication of thumb UCL injuries.

 

Depending on the severity of the Gamekeeper’s thumb, a patient may experience any (or all) of the following symptoms:

 

  • Sharp pain when resting or moving the thumb.

 

  • Swelling or inflammation in the thumb.

 

  • Instability or limited range of motion in the thumb.

 

  • Reduced thumb strength when gripping or pinching.

Who Gets Gamekeeper's Thumb?

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Anyone can develop Gamekeeper’s thumb; however, this injury commonly occurs more to children aged 15 and under. Particularly, baseball pitchers under age 15, may develop UCL tears from repeated stress. It is important to remember that pain whilst throwing is not normal for young children and should therefore be addressed immediately to prevent further injury. Overall, this injury is often caused by athletes involving sports that require throwing such as baseball, football, and basketball. Age is also a risk factor associating with a Gamekeeper’s thumb. Elders aged 65 and older have a higher risk of developing an ulnar collateral ligament injury due to wear and tear throughout the years. Other risk factors linked to Gamekeeper’s thumb include:

 

  • Reduced bone density (osteoporosis)

 

  • Direct blow

 

  • Road / traffic accident

 

  • Falling on an outstretched hand

 

  • Taking part in any rough or high-impact sport

How Does It Affect You? How Serious Is It?

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Similar to other conditions, Gamekeeper’s thumb can be caused depending on three types of severity – UCL tears are graded as follows:

 

Grade 1 – This is the least severe level of UCL tear. Stretching of the ligament may cause pain, but there is no observed tearing.

 

Grade 2 – This grade of UCL tear includes partial tearing of the ligament and is likely to produce significant amounts of pain and swelling.

 

Grade 3 – This is the most severe level of UCL tear with complete tearing of the UCL. Grade 3 tears will be accompanied by significant pain, swelling, and immobility.

 

Generally, falls, car accidents or other incidents can happen in the blink of an eye, so preventing Gamekeeper’s thumb injuries is often difficult. If you fall holding an object like a ski pole or something similar, make a conscious effort to let go of the object you are holding to avoid landing on it. When driving a car, be cautious of putting your thumbs on the inside of the steering wheel. It may take some effort to re-learn some common movements but avoiding a Gamekeeper’s thumb is invaluable.

Recommended Treatment & Rehabilitation

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A physiotherapist will first conduct a thorough evaluation that includes taking your health and activity history. Your physiotherapist may gently touch the area around your joint to locate the specific area of pain.

To provide a definitive diagnosis, your physiotherapist may collaborate with an orthopedic surgeon. The surgeon may order further tests, such as magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA), to confirm the diagnosis and to rule out other possible damage. Your physiotherapist can additionally help improve your strength and range of motion following a UCL injury. Your therapist also will work with you before and after any necessary surgery and can help identify other issues that may have contributed to your injuries, such as range of motion and strength deficits, or improper mechanics. Your physiotherapist will also help you:

 

Boost your healing process

 

Decreasing stress across the injured area is the best way to promote the healing of a Gamekeeper’s thumb injury. Your therapist will most likely tell you to take some time off from your sport or other activity. He / she may educate you on the RICE (rest, ice, compression, and elevation) principle and may implement cross-friction massage to help the body supply nutrients to the injured ligament.

 

Strengthen your muscles

 

After your injury, your hand may feel weaker. Strengthening the muscles of your shoulder, upper back, and shoulder blades in addition to those of the forearm will help decrease the stress on the joint.

 

Improve your range of motion

 

After your injury, you may notice more difficulty straightening or bending your arm. Your therapist will work with you to improve your range of motion.

 

Correct your movements

 

Whilst every sport requires different arm positions, certain positions may put an athlete at greater risk for injury to the elbow and thumb. Examining and modifying the movements you perform can help you safely return to your sport. Your physiotherapist will help design a specific program to allow a gradual full return to activity.

 

Preparing to return to sports activities 

 

An important component of preparing for a return to sports after a Gamekeeper’s thumb injury is preparing the arm to properly withstand the stress placed on it during throwing or other overhead motions. Your therapist will work with you to establish and implement a progressive program to prepare you for a return to practice and competition.

If surgery is necessary, your physiotherapist may measure your arm strength and range of motion prior to surgery to define a baseline goal to achieve following the procedure. Immediately following surgery, your arm will likely be placed in a splint, brace, or sling to protect your elbow. Many treatments are available in order to lessen the symptoms linked to Gamekeeper’s thumb, such as:

 

  • NSAIDs such as ibuprofen may help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. However, NSAIDs can cause certain side-effects, such as stomach bleeding or kidney problems to some patients.

 

  • Acetaminophen decreases pain and fever – this type of medicine can cause liver damage if not taken properly.

 

  • Supportive devices include a removable splint, elastic bandage, or a thumb cast. These are used to help decrease or prevent movement of your thumb so it can heal. They are also used to prevent further damage to your thumb. These devices may be worn for 3-6 weeks.

 

  • Physiotherapy may be recommended during and after your injury has healed. A physiotherapist teaches you exercises to help improve movement and strength.

 

As mentioned earlier, splinting and casting is appropriate for injured thumbs if the ligament is not loose or is only very slightly loose – these are known as partial tears, that is, Grade 1 or Grade 2 tears of the thumb. These tears usually involve an isolated rupture of the proper collateral ligament. Splinting or casting is also appropriate when there is a fracture, so long as the fragment of bone is displaced only a millimeter or two. The splint or cast should immobilize the thumb for 4 consecutive weeks – with appropriate treatment, good to excellent results can be expected in circa 90% of injuries.

Gamekeeper’s thumb exercises can help you feel in control during the recovery process, whether or not your tear is the result of a sports injury. If your goal is getting back to your normal routine, it is recommended to choose only the safest and most effective stretches and exercises. Here are a few exercise methods to help reduce Gamekeeper’s thumb, including the following:

 

Wrist stretch

 

Press the back of the hand on your injured side with your other hand to help bend your wrist. Then hold for 15-30 seconds. Next, stretch the hand back by pressing the fingers in a backward direction. Once again, hold for 15-30 seconds. Keep the arm on your injured side straight during this exercise, then repeat 3 more sets.

 

Wrist flexion

 

Hold a can or hammer handle in your hand with your palm facing up. Bend your wrist upwards, then slowly lower the weight and return to the starting position. Perform this exercise in 2 sets of 15 repetitions.

 

Resisted elbow flexion

 

Hold a can of soup with your palm up. Slowly bend your elbow so that your hand is coming towards your shoulder. Then lower it slowly so your arm is completely straight. Perform this method for 2 sets of 15 repetitions.

Alternative & Homeopathic Treatment

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Grade 1 and Grade 2 Gamekeeper’s thumb injuries are often successfully treated using non-surgical treatments. Some of these same treatment methods may also be used to ease Grade 3 injuries before surgery can be performed. Here are a few easy treatments any patient can do either at home or elsewhere:

 

RICE principle – Rest, ice, compression, and elevation is the first line of treatment for injuries for the first two to three days.

 

Medication – Over-the-counter pain relievers like ibuprofen or acetaminophen can help control pain associated with the injury.

 

Mobility devices – In higher grade tears, a sling may be used to help immobilize the elbow, preventing additional problems and allowing the thumb injury to begin to heal.