THUMB ULNAR COLLATERAL LIGAMENT

OVERVIEW

Day to day, we probably don’t consider just how vital our thumbs are. Without them, you would have far more difficulty executing basic actions, such as writing, lifting, and even holding most objects.

Thumb injuries can be particularly uncomfortable and potentially disabling. One specific issue is called thumb ulnar collateral ligament damage, sometimes abbreviated as a UCL injury.

ANATOMY

The collection of soft tissue called the thumb ulnar collateral ligament ensures the finger continually maintains the strength and stability needed to perform almost every important function your hands and fingers routinely carry out. This ligament is situated at the thumb’s base and prevents the finger from overextending away from your hand.

The important ligament is further divided into two supporting structures called the UCL proper and the accessory UCL. Injury or damage to either one can result in pain, immobility, and disability.

DESCRIPTION

A UCL injury is usually placed into one of two categories: Gatekeeper’s Thumb and Skier’s Thumb.

Gatekeeper’s Thumb – These are considered the more chronic and lasting UCL injuries. Such occurrences were named after ancient gamekeepers who would disable the animals they hunted by grasping their heads with their thumb and forefinger. Over time, engaging in this repetitive motion gradually loosened and weakened the hunter’s UCL ligaments.

Skier’s Thumb – This type of UCL injury happens acutely (quickly becomes severe). It is named after skiers because falls in skiing competitions can result in competitors’ hands getting caught in their ski poles. This can lead to thumb ligaments getting overstretched or torn.

CAUSES

Though the preceding descriptions are the most common way UCL ligaments are injured, any action forcing the unusual twisting or turning of your thumb can result in damage. A UCL injury typically occurs when you place increased or consistent pressure on your thumb. Such actions can stretch or tear the ligament.

SYMPTOMS

The most common symptom is pain. Besides discomfort, you might witness redness and swelling in the affected thumb. You will likely encounter significant difficulties gripping or lifting objects. Additionally, your thumb might feel loose, unstable, and hard to move.

Complications

If left unchecked, ligament damage can progress, be more challenging to treat, and possibly lead to permanent thumb deformity and pain.

Occasionally, untreated UCL injuries create a complication called a Stener lesion. This is when a small piece of bone pulls away from the UCL ligament as the injury progresses. The bone prevents the ligament from returning into the proper position and healing correctly

Diagnosis

Your doctor will first do a physical evaluation of your thumb, besides asking you when the injury occurred and the symptoms you have experienced since the event happened.

Usually, confirmation happens after examining the results of one or more internal imaging tests like an X-ray or an MRI scan (magnetic resonance imaging).

TREATMENT OVERVIEW

More severe injuries typically need more aggressive treatment. Your doctor will determine the most appropriate treatment plan after considering other factors such as your age, the length of time that has passed since the injury occurred, and how physically active you are.

NON-SURGICAL TREATMENTS

Mild to moderate events in which ligament tears are minor, and the affected thumb still enjoys relative stability, are often placed inside a movement-restricting device like a splint or cast for a healing period lasting anywhere from four to six weeks.

SURGICAL OPTIONS

If your UCL is severely or completely torn, has caused noticeable thumb instability, or has led to a chronic weakening of your thumb, you may be a candidate for corrective surgical procedures. The type of operation performed will depend on the injury’s extent.

When partial ligament tears occur, a surgeon can sew separated ends back together. Surgery to repair chronic cases often needs reconstruction of the UCL using soft tissues found in other parts of the hand or body.

Surgery is usually followed by physical therapy. When undergoing physical therapy, you perform exercises intended to help keep the thumb mobile and strong.

RECOVERY

The duration of your recovery depends on several things, including how bad the UCL injury was, and the specific treatment used. On average, you will likely be able to return to normal daily activities and competitive sports in three to four months.

PREVENTION

Typically, prevention is challenging as many thumb ulnar collateral ligament tears occur immediately following acute trauma brought forth by a fall, accident, or excessive contact in athletic competitions.

You can reduce your risk by engaging in proactive efforts like remembering to release a ski pole when tumbling during a downhill run and not driving with your thumbs inside the steering wheel.

NEXT STEPS

If you suffered an acute UCL injury or continue to cope with the lingering impact of an existing one, we urge you to contact us. Talk to your Florida Orthopaedic Institute physician today to learn more about thumb ulnar collateral ligament injury.