What is an Ulnar Collateral Ligament?
The ulnar collateral ligament of the thumb is located on the pinky side of the thumb at the metacarpal-phalangeal joint (where the finger bones meet the hand bones). It provides stability at the base of the thumb and supports grip and hand strength. Injuries are generally traumatic in nature. They commonly occur by either a fall on an outstretched thumb or by a similar position during "stick" sports such as hockey, lacrosse and field hockey. Too much stress and pressure on the ligament can lead to a sprain or fracture.
This type of injury is also commonly referred to as GameKeeper's Thumb or Skier's Thumb.
How Do I Know If My Child has an Ulnar Collateral Ligament Injury of the Thumb?
Common signs and symptoms of injury include:
- Pain, swelling, bruising at the base of the thumb
- Weakness with gripping things
- Decreased range of motion
- Catching, popping, shifting of thumb
How is an Ulnar Collateral Ligament Injury of the Thumb Diagnosed?
Your child will complete a detailed physical exam including examination of the hand. The diagnosis is generally made by history and physical exam. Depending on the length and severity of symptoms, the doctor may order hand X-rays to look for a possible fracture, growth plate injury, or other underlying structural injury or cause. They will also look for other causes of bone pain. Most injuries are treated without surgery. Complete tears or incomplete / "loose healing" may be discovered based on exam, response to treatment, and magnetic resonance imaging (MRI). Complete tears and incomplete healing may need surgery to restore strength and stability.
How is an Ulnar Collateral Ligament Injury of the Thumb Treated?
Once the diagnosis of ulnar collateral ligament injury is made, your doctor will determine the best possible treatment plan.
Conservative management
Duration of treatment can vary from several weeks to several months depending on the severity of the injury and the demands of your child's sport.
- Rest - Your doctor may recommend a period of time to avoid all stress to the hand, allowing for healing to take place.
- Immobilization - A brace, cast or splint may be used to help protect the thumb from further injury.
- Ice - This will help decrease swelling, inflammation and pain, allowing the thumb to heal.
- Medications - Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling may be recommended. Dosage and potential side effects will be discussed during your child's appointment.
- Activity changes - Your doctor may recommend changes to your child's usual physical activity specific to their sport involvement.
- Physical therapy - Range of motion and gentle strengthening exercises will be recommended to do on your own or with a physical therapist. This may begin immediately post injury or after a period of immobilization, depending on the severity of the injury.
Surgery
Most injuries do well with non-surgical treatment. Surgery may be needed in cases where there is a complete tear of the ulnar collateral ligament, or where there is a high degree of injury and continued pain or instability even with non-surgical treatments. Partial ligament injuries are treated for several months before consideration of surgery. In these cases, your sports medicine doctor will refer you to a pediatric orthopaedic surgeon at Cincinnati Children's to discuss surgical options. They will help you make the best decision for your child based on your child's long-term physical activity goals.
Preventing Ulnar Collateral Ligament Injuries
Prevention is key to having a long and successful sports career. Ulnar collateral ligament injuries can be severe and lead to significant lost time from play. Being proactive will increase your child's chances of avoiding injuries. Here are some tips to avoid these injuries:
- Follow the rules. Most sports have rules against slashing and aggressive behavior with sticks.
- Use proper-fitting protective equipment such as gloves. Pay attention to the environment and inclement weather to avoid falls.
