Today I am going to discuss a topic that is personal to me.....The Ulnar Collateral Ligament of the Thumb. Not to be confused with its much more popular cousin, the Ulnar Collateral Ligament of the Elbow that is commonly injured in baseball pitchers. I will refer to it as the Thumb UCL from here on out.
This injury is personal for me because I injured my thumb UCL when I was playing football in high school. I was making a tackle, and my thumb was bent sideways injuring the ligament. My injury was not treated properly by my orthopedist at the time, and I now have had a reconstructive surgery of the ligament and subsequent arthritis at the age of 42. If you want your child to avoid what I have had to endure, please read carefully to make sure your child gets a proper diagnosis and treatment.
The image above gives you an idea of where the ligament is. It is indicated by the blue mark. That is my thumb, and if you look closely, you can see the scar from my ligament reconstruction.
What is the Thumb UCL?
It is a tiny ligament that helps stabilize the inside part of your thumb. If we want to use some big words, it stabilizes the ulnar aspect of the first Metacarpophalangeal joint. It keeps the thumb from being forced too far away from the palm.
How is it Commonly Injured?
Anytime the thumb is forcefully pushed away from the palm, you could have an injury to the UCL of the thumb. The injury is very common in football as I described above, but it is also common in soccer and skiing. Football players either get the thumb caught in an opponent's jersey, fall on an outstretched hand or gets the thumb bent back tackling another player. Soccer players usually fall on an outstretched hand, and skiers can injure the ligament by having the thumb bent back by their poles. The UCL injury is commonly referred to as "Skiers' Thumb" for this reason.
It is also referred to as "Gamekeeper's Thumb." Gamekeepers in the past would injury the thumb UCL from the repetitive stress from killing and cleaning birds over and over again. Repetitive stress on the ligament can stretch it out over time.
Injury Severity
Just like with most ligaments, there can be very mild stretching of the ligament but also complete tearing of the ligament.
*Grade 1 - this is what we would call a mild sprain. The fibers of the ligament have been stretched just a little bit to cause discomfort, but there is not a huge injury to the ligament.
*Grade 2 - this is where we start to see some tearing of the ligament. The ligament will be stretched causing some laxity at the joint.
*Grade 3 - there will be complete tearing of the ligament with this injury. The pain and swelling will be a bit worse than the Grade 2 injury, but the most problematic thing with Grade 3 injuries is the instability of the thumb. The ligament can also pull off a small piece of bone, which we call an avulsion (see image below).
The MOST Important thing we will discuss......Treatment Options.
The way the injury is treated initially is so important. If not treated properly, there will be pain, instability, weakness and eventual arthritis of the thumb. As I mentioned before, I am living proof of what happens when it is not treated properly.
In order to determine proper treatment, it needs to be evaluated thoroughly. Your orthopedic provider will need to get x-rays and examine the thumb. He or she will be able to do some tests to stress the ligament to see how much it is damaged as well. If your provider recommends an MRI to evaluate the ligament, please do not question it. The ligament can tear off the bone, and then position itself under other structures in the thumb which will keep it from healing properly. They need to be able to evaluate all of this with an MRI.
If there is just a mild sprain, the thumb will most likely be protected with a splint with a full recovery in a relatively short amount of time. If there is significant injury to the ligament, the athlete will need to be put in a cast for 4-6 weeks to allow the ligament to heal and scar back in place. Without proper immobilization, the ligament will heal in a loose position which will cause issues down the line.
If the injury is significant enough or the ligament is in a bad position, your doctor may want to repair the ligament with surgery to restore stability and function. They can either sew the ends of the ligament back together or anchor the ligament back down to bone. There will be a period of immobilization in a cast followed by rehabilitation to regain motion and strength.
Conclusion
The biggest take away here is that it is a very treatable injury that does not cause many long-term issues if treated correctly, so please do not assume that your young person just has a sprained thumb that will heal quickly with no problem. If you have any suspicion that the UCL has been injured, take you kid to an orthopedic professional to be thoroughly evaluated to avoid long term issues.
Hunter Greene, MS, ATC, OPA-C
**Disclaimer: Please consult with a local healthcare professional for definitive diagnosis and treatment. This information should not be used to diagnose and treat injuries.
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