Skip to main content
SpringerLink
Log in

Thumb collateral ligament injuries in the athlete

  • Hand and Wrist Sports Medicine (E Tolo and L Dwyer, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this review is to identify current principles in the diagnosis and treatment of collateral ligament injuries of the thumb in the athlete.

Recent findings

Cadaver studies have clearly identified the ulnar and radial collateral ligaments origin and insertion footprints for repair or reconstruction.

Summary

Ulnar and radial collateral ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author’s preferred techniques are reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Keramidas E, Miller G. Adult hand injuries on artificial ski slopes. Ann Plast Surg. 2005;55:357–8.

    Article  CAS  PubMed  Google Scholar 

  2. Rhee PC, Jones DB, Kakar S. Current concepts review: management of thumb metacarpophalangeal ulnar collateral ligament injuries. J Bone Joint Am. 2012;94:2005–12.

    Article  Google Scholar 

  3. Lee AT, Carlson MG. Thumb metacarpophalangeal joint collateral ligament injury management. Hand Clin. 2012;28:361–70.

    Article  PubMed  Google Scholar 

  4. Moutet F, Guinard D, Lebrun C, et al. Metacarpophalangeal thumb sprains based on experience with more than 1,000 cases. Ann Chir Main. 1989;8:99–109.

    Article  CAS  PubMed  Google Scholar 

  5. •• Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments. J Hand Surg Am. 2013;38:117–23. New anatomical information regarding the anatomic footprint for repair/reconstruction.

    Article  PubMed  Google Scholar 

  6. Johnson JW, Culp RW. Acute Ulnar collateral ligament injury in the athlete. Hand Clin. 2009;25:437–42.

    Article  PubMed  Google Scholar 

  7. Posner MA, Retaillaud JL. Metacarpophalangeal joint injuries of the thumb. Hand Clin. 1992;8:713–32.

    CAS  PubMed  Google Scholar 

  8. Frank WE, Dobyns J. Surgical pathology of collateral ligamentous injuries of the thumb. Clin Orthop Relat Res. 1972;83:102–14.

    Article  CAS  PubMed  Google Scholar 

  9. Cooney 3rd WP, Chao EY. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg Am. 1977;59:27–36.

    Article  PubMed  Google Scholar 

  10. Smith RJ. Post-traumatic instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am. 1977;59:14–21.

    Article  CAS  PubMed  Google Scholar 

  11. Moberg E, Stener B. Injuries to the ligaments of the thumb and fingers: diagnosis, treatment, and prognosis. Acta Chir Scand. 1953;106:166–86.

    CAS  PubMed  Google Scholar 

  12. Gerber C, Senn E, Matter P. Skier’s thumb: surgical treatment of recent injuries to the ulnar collateral ligament of the thumb’s metacarpophalangeal joint. Ann J Sports Med. 1981;9:171–7.

    Article  CAS  Google Scholar 

  13. Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. The anatomy of the thumb metacarpophalangeal ulnar and radial collateral ligaments. J Hand Surg [Am]. 2012;37:2021–6.

    Article  Google Scholar 

  14. Tang P. Collateral ligament injuries of the thumb metacarpophalageal joint. J Am Acad Orthop Surg. 2011;19:287–96.

    Article  PubMed  Google Scholar 

  15. Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Bone Joint Surg (Br). 1962;44:869–79.

    Google Scholar 

  16. Cooper JG, Johnstone AJ, Hider P, Ardagh MW. Local anaethetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries. Emerg Med Australas. 2005;17:132–6.

    Article  PubMed  Google Scholar 

  17. Morgan WJ, Slowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg. 2001;9:389–400.

    Article  CAS  PubMed  Google Scholar 

  18. Osterman AL, Hayden G, Bora Jr FW. Quantitative analysis of thumb function after ulnar collateral repair and reconstruction. J Trauma. 1981;21:854–61.

    Article  CAS  PubMed  Google Scholar 

  19. Malik AK, Morris T, Chou D, Sorene E, Taylor E. Clinical testing of ulnar collateral ligament injuries of the thumb. J Hand Surg Eur Vol. 2009;34:363–6.

    Article  CAS  PubMed  Google Scholar 

  20. Gurdezi S, Mok D. “Sag sign”—a simple radiological sign for detecting injury to the thumb ulnar collateral ligament. J Inj. 2008;39:191.

    Google Scholar 

  21. Hintermann B, Holzach PJ, Schutz M, Matter P. Skier’s thumb—the significance of bony injuries. Am J Sports Med. 1993;21:800–4.

    Article  CAS  PubMed  Google Scholar 

  22. •• McKeon KE, Gelberman RH, Calfee RP. Ulnar collateral ligament injuries of the thumb: phalangeal translation during valgus stress in human cadaver. Bone Joint Surg Am. 2013;95:881–7. New information regarding the diagnosis of UCL tears and their extent guiding further management.

    Article  Google Scholar 

  23. Hergan K, Mittler C. Sonography of the injured ulnar collateral ligament of the thumb. J Bone Joint Surg (Br). 1995;77:77–83.

    CAS  Google Scholar 

  24. Susic D, Hansen BR, Hansen TB. Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb. Scand J Plast Reconstr Surg Hand Surg. 1999;33:319–20.

    Article  CAS  PubMed  Google Scholar 

  25. Ahn JM, Sartoris DJ, Kang HS, Bottle MJ, Trudell D, Haghighi P, et al. Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers. Radiology. 1998;206:737–44.

    Article  CAS  PubMed  Google Scholar 

  26. Hergan K, Mittler C, Oser W. Ulnar collateral ligament: differentiation of displaced and non-displaced tears with US and MR imaging. Radiology. 1995;194:65–71.

    Article  CAS  PubMed  Google Scholar 

  27. Bowers WH, Hurst LC. Gamekeeper’s thumb. Evaluation by arthrography and stress roentgenography. J Bone Joint Surg Am. 1977;59:519–24.

    Article  CAS  PubMed  Google Scholar 

  28. Abrahamsson SO, Sollerman C, Lundborg G, Larsson J, Egund N. Diagnosis of displaced ulnar collateral ligament of the metacarpophalageal joint of the thumb. J Hand Surg [Am]. 1990;15:457–60.

    Article  CAS  Google Scholar 

  29. Sollerman C, Abrahamsson SO, Lundborg G, Adalbert K. Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. A prospective randomized study of 63 patients. Acta Orthop Scand. 1991;62:524–6.

    Article  CAS  PubMed  Google Scholar 

  30. Landsman JC, Seitz Jr WH, Froimson AI, Leb RB, Bachner EJ. Splint immobilization of gamekeeper’s thumb. Orthopedics. 1995;18:1161–5.

    CAS  PubMed  Google Scholar 

  31. Pichora DR, McMurtry RY, Bell MJ. Gamekeepers thumb: a prospective study of functional bracing. J Hand Surg [Am]. 1989;14:567–73.

    Article  CAS  Google Scholar 

  32. Kuz JE, Husband JB, Tokar N, McPherson SA. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. J Hand Surg [Am]. 1999;24:275–82.

    Article  CAS  Google Scholar 

  33. Sorene ED, Goodwin DR. Non-operative treatment of displaced avulsion fractures of the ulnar base of the proximal phalanx of the thumb. Scand J Plast Reconstr Surg Hand Surg. 2003;37:225–7.

    Article  PubMed  Google Scholar 

  34. Dinowitz M, Trumble T, Hanel D, Vedder NB, Gilbert M. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. J Hand Surg [Am]. 1997;22:1057–63.

    Article  CAS  Google Scholar 

  35. Katolik LI, Friedrich J, Trumble TE. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques. Plast Reconstr Surg. 2008;122:1451–6.

    Article  CAS  PubMed  Google Scholar 

  36. Derkash RS, Matyas JR, Weaver JK. Acute surgical repair of the skier’s thumb. Clin Orthop Relat Res. 1987;216:29–33.

    Google Scholar 

  37. Zeman C, Hunter RE, Freeman JR, Purnell ML, Mastrangelo J. Acute skier’s thumb repaired with a proximal phalanx suture anchor. Am J Sports Med. 1998;26:644–50.

    CAS  PubMed  Google Scholar 

  38. Kozin SH. Treatment of thumb ulnar collateral ligament ruptures with the Mitek bone anchor. Ann Plast Surg. 1995;35:1–5.

    Article  CAS  PubMed  Google Scholar 

  39. Kato H, Minami A, Takahara M, Oshio I, Hirachi K, Kotaki H. Surgical repair of acute ulnar collateral ligament injuries in digits with the Mitek bone suture anchor. J Hand Surg (Br). 1999;24:70–5.

    Article  CAS  Google Scholar 

  40. Weiland AJ, Berner SH, Hotchkiss RN, McCormack Jr RR, Gerwin M. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor. J Hand Surg [Am]. 1997;22:585–91.

    Article  CAS  Google Scholar 

  41. Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg. 2009;13:7–10.

    Article  PubMed  Google Scholar 

  42. Haddock NT, Beasley RW, Sharma S. Thumb metacarpophalangeal joint ulnar collateral ligament repair with condylar shaving. Tech Hand Up Extrem Surg. 2009;13:199–201.

    Article  PubMed  Google Scholar 

  43. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal ulnar collateral ligament tears. J Hand Surg [Am]. 1995;20:1037–42.

    Article  CAS  Google Scholar 

  44. Bean CH, Tencer AF, Trumble TE. The effect of thumb metacarpophalangeal ulnar collateral ligament attachment site on joint range of motion: an in vitro study. J Hand Surg [Am]. 1999;24:283–7.

    Article  CAS  Google Scholar 

  45. Arnold DM, Cooney WP, Wood MB. Surgical management of chronic ulnar collateral ligament insufficiency of the thumb metacarpophalangeal joint. Orthop Rev. 1992;21:583–8.

    CAS  PubMed  Google Scholar 

  46. Samora JB, Harris JD, Griesser MJ, Ruff ME, Awan HM. Outcomes after injury to the thumb ulnar collateral ligament—a systematic review. Clin J Sport Med. 2013;23:247–54.

    Article  PubMed  Google Scholar 

  47. McCue 3rd FC, Hakala MW, Andrews JR, Gieck JH. Ulnar collateral ligament injuries of the thumb in athletes. J Sports Med. 1974;2:70–80.

    Article  PubMed  Google Scholar 

  48. Neviaser RJ, Wilson JN, Lievano A. Rupture of the ulnar collateral ligament of the thumb (gamekeeper’s thumb). Correction by dynamic repair. J Bone Joint Surg Am. 1971;53:1357–64.

    Article  CAS  PubMed  Google Scholar 

  49. Kaplan EB. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. J Bone Joint Surg Am. 1961;43:541–6.

    Article  PubMed  Google Scholar 

  50. Sakellarides HT, DeWeese JW. Instability of the metacarpophalangeal joint of the thumb. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. J Bone Joint Surg Am. 1976;58:106–12.

    Article  CAS  PubMed  Google Scholar 

  51. Strandell G. Total rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb: results of surgery in 35 cases. Acta Chir Scand. 1959;118:72–80.

    CAS  PubMed  Google Scholar 

  52. Fairhurst M, Hansen L. Treatment of “Gamekeeper’s Thumb” by reconstruction of the ulnar collateral ligament. J Hand Surg (Br). 2002;27:542–5.

    Article  CAS  Google Scholar 

  53. Frykman G, Johansson O. Surgical repair of rupture of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. Acta Chir Scand. 1956;112(1):58–64.

    CAS  PubMed  Google Scholar 

  54. Guelmi K, Thébaud A, Werther JR, Candelier G, Barbato B, Doursounian L. Bone-retinaculum-bone reconstruction for chronic posttraumatic instability of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. 2003;28:685–95.

    Article  Google Scholar 

  55. Alldred AJ. Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg (Br). 1955;37:443–5.

    Article  Google Scholar 

  56. Edelstein DM, Kardashian G, Lee SK. Radial collateral ligament injuries of the thumb. J Hand Surg [Am]. 2008;33:760–70.

    Article  Google Scholar 

  57. Melone Jr CP, Beldner S, Basuk RS. Thumb collateral ligament injuries. An anatomic basis for treatment. Hand Clin. 2000;16:345–57.

    PubMed  Google Scholar 

  58. Lyons RP, Kozin SH, Failla JM. The anatomy of the radial side of the thumb: static restraints in preventing subluxation and rotation after injury. Am J Orthop. 1998;27:759–63.

    CAS  PubMed  Google Scholar 

  59. Coyle Jr MP. Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: treatment by soft tissue advancement and bony reattachment. J Hand Surg [Am]. 2003;28:14–20.

    Article  Google Scholar 

  60. Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015;34:117–26.

    Article  PubMed  Google Scholar 

  61. Doty JF, Rudd JN, Jemison M. Radial collateral ligament injury of the thumb with a Stener-like lesion. Orthopedics. 2010;33:925.

    PubMed  Google Scholar 

  62. Catalano 3rd LW, Cardon L, Patenaude N, Barron OA, Glickel SZ. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. J Hand Surg [Am]. 2006;31:68–75.

    Article  Google Scholar 

  63. Durham JW, Khuri S, Kim MH. Acute and late radial collateral ligament injuries of the thumb metacarpophalangeal joint. J Hand Surg [Am]. 1993;18:232–7.

    Article  CAS  Google Scholar 

  64. Horch RE, Dragu A, Polykandriotis E, Kneser U. Radial collateral ligament repair of the thumb metacarpophalangeal joint using the abductor pollicis brevis tendon. Plast Reconstr Surg. 2006;117:491–6.

    Article  CAS  PubMed  Google Scholar 

  65. McDermott TP, Levin LS. Suture anchor repair of chronic radial ligament injuries of the metacarpophalangeal joint of the thumb. J Hand Surg (Br). 1998;23:271–4.

    Article  CAS  Google Scholar 

  66. • Carlson MG. Commentary on RCL/UCL injury in basketball. Hand Clin. 2012;28:373–5. New commentary from experts in the field regarding sport specific management.

    Article  PubMed  Google Scholar 

  67. •• Chhor KS, Culp RW. Baseball commentary “thumb ligament injuries: RCL and UCL”. Hand Clin. 2012;28:371–2. New commentary from experts in the field regarding sport specific management.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA

    Daniel M. Avery III, Elizabeth R. Inkellis & Michelle G. Carlson

Authors
  1. Daniel M. Avery III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth R. Inkellis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle G. Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle G. Carlson.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Human and animal rights and informed consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines). This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Hand and Wrist Sports Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Avery, D.M., Inkellis, E.R. & Carlson, M.G. Thumb collateral ligament injuries in the athlete. Curr Rev Musculoskelet Med 10, 28–37 (2017). https://doi.org/10.1007/s12178-017-9381-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-017-9381-z

Keywords

Search

Navigation