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Gamekeeper Thumb


Gamekeeper’s thumb was originally described by Campbell in 1955 when he reported chronic laxity of the ulnar collateral ligament (UCL) of the thumb in 24 Scottish gamekeepers. The injury occurred as gamekeepers sacrificed wounded rabbits and other small game by breaking their necks between the ground and their thumbs and index fingers.

Today, this injury is more a result of delayed treatment of an acute injury. The alternative term skier’s thumb was popularized by Gerber et al and has become more synonymous with an acute injury. A significant proportion of these injuries are a result of fall or blows to the thumbs. One of the common mechanisms is a skier landing against the ski pole or ground while the thumb is abducted causing a valgus force on the thumb.

Gamekeeper’s thumb, or skier’s thumb, may constitute up to 50% of hand injuries in skiers. It may also be seen in patients with rheumatoid arthritis, those who have been in a motor vehicle accident, and athletes of other sports with injuries resulting from a fall onto an outstretched hand with an abducted thumb. MRI can establish the integrity of the ulnar collateral ligament. MRI can also distinguish between a Stener lesion and a nondisplaced or minimally retracted tear. Ultrasonography is also considered safe and accurate.

Complete UCL tears require surgical intervention. Gamekeeper’s fractures are usually treated conservatively, but those involving more than 30% of the joint surface and those that are malrotated or displaced should not be manipulated. Those fractures are indications for surgical intervention.

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