Skiers/ Gamekeepers' Thumb
What is it?
Skiers, or Gamekeepers thumb, also know as a collateral ligament rupture, is caused by injury to the very strong ligament that stabilizes the large joint of the thumb. The ligament is very important as it allows you to form a strong pinch grip with the index finger, which is vital for good hand function.
It was originally described in gamekeepers, hence the name. The problem arose from repeated strain placed on the ligament when the gamekeepers dispatched rabbits and game birds by wringing their necks and is a chronic injury. Skiers thumb refers to an acute injury to the thumb.
What causes it?
Most commonly it is caused by an acute injury, causing the thumb to be "bent backwards", such as falling on an outstretched hand whist holding a ski pole, or whilst holing onto handlebars of a bike.
Less commonly it can occur in people with rheumatoid arthritis of the hand.
What are the symptoms?
Most patients present with a history of a fall or trauma to the thumb with subsequent pain and swelling around the thumb joint. Patients may also complain of a feeling of weakness in pinch grip and a sensation that the thumb feels "unstable".
Do I need any further investigations?
Yes. All patients will require an x-ray to exclude an associated fracture around the thumb. Some patients may need an ultrasound scan or MRI to confirm the diagnosis. Sometime if the thumb is too painful to examine, Andy may inject the joint with local anaesthetic to allow him to make the diagnosis.
What is the treatment?
If the ligament is strained or sprained then a period of plaster immobilization and/ or splinting will be required for around 6 weeks.
If the ligament is ruptured then it needs to be repaired surgically to give you the best possible function.
The operation is carried out under a general anaestehtic as a day case procedure. A 5-6 cm incision is made over the joint and the ligament is reattached to the bone on the thumb using a very strong metal anchor and sutures.
In cases of chronic rupture, repair may not be possible in which case the ligament will need to be reconstructed using a "spare" tendon from the wrist.
How long will it take to recover?
Recovery from this operation takes around 6 weeks. A temporary plaster splint will be applied to the thumb after the operation. You will be seen by a hand therapist at 2 days will get you moving your hand very early after surgery to avoid stiffness.
The stiches are under the skin but will need to be trimmed at 2 weeks. Following this a short thumb plaster will be applied for a further 2 weeks. Once the plaster is removed your hand therapist will build a custom plastic splint that you will need to wear for a further 3-4 weeks. During this time your hand therapist will get you moving your hand more and more and will also advise how to help soften and desensitize the scars
What are the potential complications?
Any surgical procedure carries risks, however every effort is made to minimize these to ensure the best possible outcome from your surgery.
- Infection - Uncommon and usually treated very successfully with antibiotics
- Delayed healing - Smokers and those with diabetes are more prone to this.
- Painful/Tender Scars - Rigorous wound care and desensitization as directed by your hand therapist help prevent this.
- Numbness around the scar - there are several small nerves that supply the sensation to the skin of the thumb. There is a risk that during the operation they maybe damaged or stretched, causing a small area of numbness on the thumb. This general resolves with time.
- Stiffness - Operations to the hand may cause stiffness, this can be minimized by working closely with your hand therapist and getting your hand moving as early as possible.
- Re-rupture of the ligament - this is uncommon and can be avoided by adhering to the instructions and splinting given to you by your hand therapist.
- CRPS - An uncommon but potentially serious complication of hand surgery leading to pain, swelling and discomfort. It is impossible to predict this problem but working closely with you hand therapist and getting your hand moving early has been proven to significantly reduce the risk of this.
When can I get back to normal activities?
The hand MUST be kept clean and dry for 14 days until the sutures are trimmed you should be able to return to "desk job" type activities within 2 weeks of the operation. Any manual work, heavy lifting or sporting activities should be avoided for at least 6 weeks. You should avoid certain activities that put strain on the thumb such as cycling or skiing for at least 3 months.
You may return to driving in around 4-6 weeks. Please inform your insurance company that you have recent hand surgery to ensure that are happy for you to do so.