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Background & Etiology

Ligaments are fibrous bands of connective tissue made of collagen, which join bone to bone. Ligaments provide stability and limit excessive motion of the joint. Gamekeeper’s thumb is an injury to the ulnar collateral ligament (UCL) in the thumb. In the thumb, the joint is the hinge that allows the finger to bend.

The thumb is an important part of the hand that allows us to grip objects, and perform many daily tasks. An injury to the UCL can cause instability that significantly impairs the thumb’s function on the involved hand. A UCL injury can range from a tear, to a more severe complete rupture.

The term Gamekeeper’s thumb dates back to the early 1950’s, when the condition was first observed among “gamekeeper’s” hunters in the United Kingdom and Scotland that put excess pressure on their thumb through the motions of the hand required to participate in hunting small game.

Gamekeeper’s thumb refers to a condition that develops as a result of chronic, or repeated, overuse or injury. When an acute (sudden) injury occurs to the UCL, it is sometimes referred to as skiers thumb. Several factors can cause Gamekeeper’s thumb including:

  • Fall on an outstretched hand, particularly when the thumb is in an abducted position, separated away from the palm position
  • Overuse or repetitive motion of the thumb and hand
  • Athletic activities (like skiing) where a fall will put pressure on the thumb
  • Instability in the thumb
  • Pain and weakness that impedes the ability to make grasping or pinching motions
  • Swelling and ecchymosis (severe bruising) of the thumb
  • Difficulty completing everyday tasks that require the use of the thumb, like tying your shoes or buttoning a shirt.
  • Loss of motion of the thumb

If an individual suspects they have Gamekeeper’s thumb, the initial treatment should consist of avoiding the positions and activities that produce the pain. A physician will need to evaluate the injury to determine if it is a partial tear (sprain) or a complete tear (rupture) as this will affect the course of treatment. X-rays will be taken to evaluate the injury.

A course of conservative treatment is usually recommended for a partial tear that would include rest and immobilization (with a splint or wrist brace,) ice, as well as hand therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy.

In severe cases of a total rupture, surgical intervention may be needed to correct the condition. A complete tear can be complicated by the development of a Steiner lesion, a loss of blood to the adductor pollicis muscle in the thumb that comes between the UCL and the place where it attaches to the bone. When this occurs the UCL will not heal and surgery may be indicated.

Hand Therapists are occupational or physical therapists, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Gamekeeper’s thumb include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a hand therapist to regain mobility and range of motion of the thumb and hand.
  • Splinting to support or rest affected area
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the hand and effected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement technique and mechanics (for example, throwing or lifting activities) in daily use of the involved upper extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the hand.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy that include:

  • REST and ICE
  • Splint or brace to support the affected area
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the condition

Prognosis

Some patients recover full function following a course of conservative care that includes hand therapy, medication and/or injections. If surgery is required, it can take longer for full motor function of the hand to return. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Gamekeeper’s thumb.

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"Although getting released from physical therapy is a great thing, today was bitter sweet. How often do you get to rehab with your twin daughters at a place that makes you feel important, special and at home? Twin Boro Physical Therapy in Middletown has been our home away from home for the past three months. We always looked forward to our sessions because they helped us gain back the life we had before. From the phone calls with Stephanie scheduling appointments (all three of us simultaneously) to our awesome therapists: Andrew, Chris, Sydney, Brad, Justin & Anthony, to our PT assistants: Ryan, Gerard, Julian and the girls, we can't thank you enough! We couldn't even walk on two feet when we arrived. Today, we successfully completed "Boot Camp' running, hopping and jumping! We appreciate all that you have done. We will truly miss you all, but you have taught us well. We are forever grateful."

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"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

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