UMEM Educational Pearls


25 year-old male presents after falling off his bicycle. He complains of pain in his right-hand (he is right-hand dominant). What's the diagnosis? 


Answer: Gamekeeper's thumb or Skier's thumb

Injury to the ulnar collateral ligament (UCL) secondary

  • repetitive injury to hand
  • acute hyper-abduction injury to the thumb (i.e., during a skiing injury or fall on outstretched hand); most common cause if injury. 

Called “Gamekeeper Thumb” because injury was originally described in gamekeepers who job was to break the necks of captured game (or animals). The act of breaking necks led to a repetitive stress and injury secondary to the valgus forces on the thumb.

UCL can become torn or avulsed from the insertion on the proximal phalanx; the UCL is an important stabilizer of the thumb; improper management can lead to future disability.  

Treatment is with a short-arm thumb-spica cast and follow up with a hand surgeon to determine whether management will be conservative or operative.

Chuter GS, Muwanga CL, Irwin LR (June 2009). "Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience"Injury 40 (6): 652–6 Wheeless' Textbook of Orthopaedics Online: Surgical treatment of acute gamekeeper's thumb


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