The Thumb

  • Steven F. Viegas


A complete tear of the ulnar collateral ligament of the thumb metacarpal phalangeal joint can be a disabling injury. This injury has been called a “gamekeeper’s thumb.” It has also been called a “skier’s thumb.” However, it can result from any activity or injury that results in hyperabduction of the thumb. It is important to discern whether there is an avulsion fracture associated with the ligament injury and whether or not the rupture is complete. If there is no fracture component to the injury and it is a complete ligament tear, there is a significant chance that the ligament would have avulsed off the base of the proximal phalanx and lies reflected back on itself with the adductor aponeurosis and extensor hood of the thumb interposed between the ligament and its normal area of attachment. This type of pathoanatomy was described by Stener and will not heal if treated nonsurgically (Fig. 8–1). Stress testing in at least 30° of flexion is important to assess whether the disruption is complete. Complete disruption of the ulnar collateral ligament will result in greater than 40° of instability with radially directed stress on the proximal phalanx of the thumb when the MCP joint is in 30° of flexion. Complete disruption of the ulnar collateral ligament is associated with some degree of disruption of the capsule of the MCP joint. If the disruption is determined to be complete and has no avulsion fracture component, the injury should be surgically explored and the ligament repaired.


Proximal Phalanx Metacarpophalangeal Joint Ulnar Collateral Ligament Volar Plate Thumb Opposition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Recommended Reading

  1. Cooney, W.P., D. Arnold, and J. Grace. 1990. Collateral ligament injury of the thumb. Adv. Orthop. Surg. 13:235.Google Scholar
  2. Goldner, J. L., A. L. Koman, R. Gelberman, S. Levin, and R. D. Goldner. 1990. Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults. Adjunctive treatment of thumb-in-palm deformity in cerebral palsy. Clin. Orthop. Rel. Res. 253:75.Google Scholar
  3. Kjaer-Petersen, K., O. Langhoff, and K. Andersen. 1990. Bennett’s fracture. J. Hand Surg. 15:58.Google Scholar
  4. Manske, P. R., M. D. Rotman, and L. A. Dailey. 1992. Long term functional results after pollicization for the congenitally deficient thumb. J. Hand Surg. 17A:1064.Google Scholar
  5. Nalebuff, E. A. 1968. Diagnosis, classification, and management of rheumatoid thumb deformities. Bull. Hosp. Joint Dis. 29:119.PubMedGoogle Scholar
  6. Stener, B. 1962. Displacement of the ruptured ulnar collateral ligament of the metacarpal phalangeal joint of the thumb: a clinical and anatomical study. J. Bone Joint Surg. 44B:869.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Steven F. Viegas
    • 1
  1. 1.Division of Hand Surgery, Department of Orthopaedic SurgeryUniversity of Texas Medical BranchGalvestonUSA

Personalised recommendations