UCL Injuries

What are UCL Injuries (Gamekeeper's or Skier's Thumb)?

Thumb ligament injuries are common. The most common injury occurs to the ligaments at the metacarpophalangeal (MP) joint located at the base of the thumb. When the thumb is forcefully bent sideways away from the rest of the hand, it can tear a ligament called the ulnar collateral ligament (UCL). The torn ligament makes gripping and pinching painful, and joint instability can lead to arthritis over time. This is the type of injury that occurs when gripping a ski pole that gets stuck, hence the name skier’s thumb. Chronic UCL injuries are called gamekeeper's thumb.

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Illustration of a hand showing an ulnar collateral ligament sprain, labeled parts include metacarpal, phalanx, and torn ligament.

A look at thumb ligament anatomy

The ulnar collateral ligament (UCL) is a thick band of tough, fibrous tissue located on the inner side of your thumb's MP joint — the hinge at the base where your thumb connects to your hand. It stretches between the metacarpal bone (in your hand) and the proximal phalanx (first thumb bone), forming a strong anchor that prevents the thumb from bending outward. This ligament works alongside the joint capsule and nearby tendons to provide stability during pinching, gripping and thumb-to-finger opposition.

Overview

Symptoms

Causes

Diagnosis

Why treatment matters

Treatment recommendations depend on injury severity, timing and whether or not arthritis is present in the joint. Your activity level, job requirements, and preferences are also important to consider.

Nonoperative treatment

Splinting and casting are the mainstays of nonoperative treatment. It typically takes 4-6 weeks for the ligament to heal sufficiently for light use and may take longer before return to sports. Sometimes the ligament does not adequately heal with splinting or casting.

Operative treatment

Surgical treatment for recent UCL injuries typically involves repairing the torn ligament back down to the bone with suture. When the joint is still healthy, but the UCL injury is too old and scarred to repair, we can use a small tendon graft to reconstruct the UCL ligament.

When the UCL injury is very old, and the joint has become arthritic, we often recommend permanently fusing the joint, which eliminates the problem of the arthritis, but also partially limits thumb motion and takes longer to recover from. Outcomes are much better when you get the UCL injury treated within the first couple weeks, before the ligament scars in and arthritis sets in.

Take the next step

Our board-certified specialists are here to help you heal. They can often diagnose the problem in one visit and get you started with a personalized treatment plan. We offer a wide variety of treatment options.