UCL or Ulnar Collateral Ligament injury (Game Keepers thumb) leads to instability and pain on the ulnar (little finger) side of the thumb. Clinical examination to assess site of pain, tenderness, stress test of the MCP joint of the thumb gives enough pointers to diagnose, however the extent of the tear wouldn’t be easy to decipher.

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Diagnosis

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X-ray. X-ray is performed and is useful to rule out any bone avulsion injuries, however, ligaments are not visible on the X-ray.

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MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the UCL ligament injury. In addition, it helps to assess the condition of the rest of the MCP joint of the thumb. It also helps to check for the Stener lesion. 

 

 

Treatment

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Non-surgical Treatment

 

Thumb UCL ligament injuries can be treated with a thumb spica splint for 6 weeks. In majority of patients this would be sufficient. If healing well this would be followed by stretching exercises to get the mobility back. In patients with poor healing or no improvement, it becomes necessary to get an MRI Scan done to assess the extent of the injury.

 

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Partial UCL Ligament tears

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In partial tears which have refused to heal with simple splinting, a PRP (Platelet Rich Plasma) Injection and a plaster cast for 4 weeks is recommended. Here PRP stimulates the healing process and the cast immobilizes so that the ligament can stand a better chance to heal.

 

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Complete UCL Ligament tears

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Complete UCL ligament tears need either the ligament repair or reconstruction. Depending upon the condition of the remaining ligament tissue, either repair of reconstruction can be done. UCL repair with fiberwire and fixation to the phalangeal end using suture anchor is an option if the remaining ligament tissue is in good condition. Alternatively, UCL ligament reconstruction using palmaris longus tendon harvested from the forearm of the same side is an effective way of stabilizing thumb. Alternatively, fiber-tape can be used to reconstruct the ligament. 

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Rehabilitation

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Post-surgery, you can expect to be in a thumb splint for 4 weeks if repair is performed. In patients with ligament reconstruction physiotherapy starts early. Range of movement exercises will start after 4 days. After 4 weeks strengthening exercises for the muscles controlling the thumb and hand. Full functionality of the thumb can be achieved by 3 months.