Dr. Wayne Weil: Hi, my name is Dr. Wayne Weil. I’m one of the surgeons here at Orthopedic Specialists of Seattle. My specialty is hand and elbow surgery, I did my medical school training at the New York University, School of Medicine in New York City. I did my orthopedic surgery residency at the Hospital for Joint Diseases in New York City. And then, I moved out here to Seattle for my hand surgery fellowship at the University of Washington and Harborview hospital.
Today, I’d like to talk to you about Ulnar Collateral Ligaments to the thumb, commonly known as a Gamekeeper’s Thumb or Skier’s Thumb. The weather here in Seattle is changing, we’re transitioning from fall and into winter, there is some early snow in the mountains and I’m sure in another month or two, we will all be out in the mountains skiing in the great Pacific Northwest. Unfortunately, some of us will have some falls and some of us will end up with a Skier’s Thumb.
Skier’s Thumb is an injury to the Ulnar Collateral Ligament to the thumb that is the main stabilizer to the thumb joint, metacarpophalangeal joint, this joint right here. And that’s a really important ligament for us in the hand and that’s what provides us stability with power pinch and grip activities. Without this ligament what happens when we power page is that, the thumb unstably pissed in his back and that creates weakness with power pinch. That instability as well can cause pain and then over time, that instability can lead to Arthritis. So, it’s an important ligament in the hand in terms of overall hand function and it’s one that if it’s injured, needs proper treatment.
These injuries have a varied presentation and that some are just sprains and others are complete ruptures. The sprains and partial tears to the Ulnar Collateral Ligament can oftentimes be treated conservatively with either hand therapy or splints or cast. And then, the injuries are more severe that cause a complete rupture with retraction of that ligament, those end up requiring surgical treatment again to restore the functionality of the hand for power pinch and grip to give us a stable and powerful thumb for our power pinch and grip activities.
The Ulnar Collateral Ligament sits right by the metacarpophalangeal joint. And that we can see here on this side of the farm in here and in here. The Ulnar Collateral Ligament holds together the metacarpophalangeal joint which is comprised of the Proximal Phalanx of the thumb which is down here and the metacarpal bone of the thumb, hence the name metacarpophalangeal joint.
With ligaments injuries that are complete and retracted, surgical treatment is warranted. The reason we perform surgery again is; to restore that power pinch and power grip, alleviate pain and restore people’s ability to return back to the activities they love like Skiing. What surgery entails is essentially making a small incision along the side of the thumb in here, where the ligaments sits, and finding where the ligament has retracted. Typically, it pulls off of the Proximal Phalanx and we drill a hole in the insertion site for the ligament in the Proximal Phalanx. And then with specialized anchors, we can take that ligament and anchor it back down into its normal resting position.
Then after surgery, typically people are in a splint for two to three days and then see a occupational hand therapist and therapy is began, just start working on thumb range of motion and early pinch and grip activities. Typically, people are back to normal activities like skiing and power pinch and grip activities at about 6 weeks after surgery.
The prognosis for people who undergo surgery and have their Ulnar Collateral Ligament repaired, is excellent and typically there are no long-term issues like Arthritis or pain or weakness after surgical repair. We would expect full return back to sport and full activity, after surgical repair of Ulnar Collateral Ligament injuries. One of the great examples of this is; just recently in the NFL, roughly two to three months ago, Drew Brees had an Ulnar Collateral Ligament injury to his thumb. He underwent surgical repair and is now back to playing full time in the NFL, without any issues.