Gamekeeper’s Thumb: The Sprain With the Funny Name

Despite the name, gamekeeper’s thumb isn’t the pain you may experience from playing too many word puzzles on your phone. The condition has been around much longer than the concept of screen time. A gamekeeper thumb injury is a sprain caused by bending the digit backward or to the side, damaging the ulnar collateral ligament (UCL). 

This chronic hand problem comes from thumb overuse over time, or an accident, like a fall. If the cause is an acute injury from an accident, it may be called a “skier’s thumb” because the UCL is prone to tearing when someone falls while holding ski poles. Men account for 60% of gamekeeper’s thumb cases. 

Read on for the answer to the biggest burning question: Why is it called gamekeeper’s thumb? Plus, find out when to see a doctor for this type of sprain and how long it typically takes to recover.

What Is Gamekeeper’s Thumb?

Gamekeeper’s thumb got its name from a surgeon in Scotland who noticed a certain injury prevalent in animal caretakers. Holding animals as they wiggled and squirmed strained the thumb joint day after day. 

Not a gamekeeper? Thumb pain from an ulnar collateral ligament injury can happen to anyone whose hands take a beating in work or play. Hand physicians often see it in rock climbers, skiers, and athletes who throw or catch balls.

The UCL is a thick band of tissue at the base of the thumb. It’s part of the joint that connects the thumb to the hand and helps stabilize it. The UCL is located on the inside edge of the joint, closest to the crease between the thumb and pointer finger. 

Gamekeeper’s thumb varies in severity, depending on the injury:

• A partial tear
• A full tear
• Detachment from the lower thumb bone (metacarpal) or mid-thumb bone (phalanx)

Gamekeeper’s thumb can be a chronic overuse injury or a traumatic injury. An overuse injury occurs over time from repetitive motion. A traumatic or sudden injury tends to happen when the thumb takes a forceful hit while fully extended, aka a FOOSH injury. It’s associated with falls as well as sports and activities that put extreme pressure on the hands. 

The terms gamekeeper’s thumb, skier’s thumb, and breakdancer’s thumb are often used interchangeably.

Signs of Gamekeeper’s Thumb

The symptoms may be signs that you have Gamekeeper’s thumb:

• Pain at the base of the thumb
• Swelling
• Weakness
• Bruising
• Difficulty pinching or grasping
• Difficulty throwing objects
• Unstable feeling

Mild symptoms at the base of the thumb can be signs of chronic overuse that can lead to a ligament sprain. If the pain continues to increase, it may indicate the early stages of Gamekeeper’s thumb.  See a physician if these symptoms don’t improve with at-home treatments, discussed later in this article.

How Are Thumb Sprains Classified?

Gamekeeper’s thumb is a type of sprain. Sprains are graded by severity based on how much damage has occurred to the ligament. The extent of the sprain determines the best treatment plan. 

• Grade 1 (mild thumb sprain): The ligament is stretched but not torn, causing pain and some swelling.
• Grade 2 (moderate thumb sprain): The ligament is partially torn, causing greater pain, swelling, and some loss of function.
• Grade 3 (severe thumb sprain): The ligament is severed or detached from the bone, accompanied by extreme pain and swelling, bruising, and possibly a lump, deformity, or total loss of movement

When to See a Hand Specialist

You should never hesitate to have a physician evaluate an injury if you are worried about it, if it’s bothersome, or if it doesn’t improve with over-the-counter remedies. 

As a rule of (ahem) thumb, it’s time to see a physician for Gamekeeper’s thumb symptoms if they don’t improve after 14 days of at-home care. Seek immediate attention if you have severe symptoms, your thumb looks crooked, or you can’t move it.

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Even a mild sprain can lead to long-term complications if not treated properly and thoroughly. An untreated case of Gamekeeper’s thumb may cause chronic pain, instability, and arthritis.

Diagnosis for Gamekeeper’s Thumb

If you present with gamekeeper’s thumb symptoms, a hand specialist will consider your lifestyle, activities, and medical history to determine if you have experienced or been exposed to any gamekeeper’s thumb causes. The physician will ask if you have had a recent fall or accident.

The physical exam for the gamekeeper’s thumb involves moving your thumb into different positions to check the joint’s stability and comparing it to the other thumb. 

Imaging Tests for Gamekeeper’s Thumb

The physician may order diagnostic tests to determine the severity of the injury. These include:

• X-ray: to check for a fracture or compare the injured hand to the uninjured hand
• Stress X-ray: image taken while the doctor applies pressure to the injury
• MRI or ultrasound: to determine the extent and location of a tear

Treatment

Gamekeeper’s thumb is usually treated conservatively with nonsurgical approaches. A complete tear may require immediate surgery. The treatment plan depends on the severity of the injury and the patient’s tolerance for pain and lost function. Typically, the recovery time for a gamekeeper thumb injury lasts two to 12 weeks.

At-home Care

If the pain isn’t serious and you can still use your thumb, you may try the typical RICE protocol for sprains. You may also take over-the-counter anti-inflammatories and use a store-bought brace or bandage to stand in for a Gamekeeper’s thumb splint. 

Follow these tips to RICE a case of Gamekeeper’s thumb:

• Rest: Try not to use your thumb for 48 hours.
• Ice: Apply a covered ice pack to the base of the thumb for 20 minutes, a few times a day. 
• Compression: Wear a thumb-and-wrist brace continuously throughout the day to reduce swelling.
• Elevation: Rest your hand on your shoulder or a surface higher than your heart a few times a day. 

Nonsurgical Options

Mild to moderate sprains may improve significantly with these nonsurgical remedies. 

• Splinting or wearing a cast: You may have to wear a thumb splint (or cast that extends past your wrist) to immobilize and protect the thumb for four to six weeks so it can heal.
• Therapy: IHTSC’s in-house therapy center can help you rebuild strength and flexibility while your thumb heals.

Surgery

For severe cases of gamekeeper’s thumb, surgery may be required to repair a full or near-complete tear or reattach the ligament to the bone. The procedure is called a thumb UCL repair. 

After gamekeeper’s thumb surgery, recovery usually lasts up to 12 weeks and includes wearing a cast, splinting, and therapy. 

Gamekeeper’s Thumb Prevention

Skiers and other athletes should take care to follow proper techniques to protect the thumb joint. Skiers should let go of poles if they are falling, use poles with finger-tip grooves, and wear gloves designed for skiing. Other athletes should wear protective gear, warm up, and regularly stretch their fingers and wrists.

Why Patients Give IHTSC’s Doctors Two Thumbs Up

Gamekeeper’s thumb is one of many chronic overuse injuries that can affect your joints. Here at IHTSC, our hand specialists have extensive experience with this injury and almost all other disorders of the hand, wrist, elbow, and shoulder. 

“Dr. Smetana was one of the first people I’d talked to about my hand pain who didn’t think I was crazy. He actually listened to me,” says IHTSC patient Emily M. “After surgery, it didn’t take long to see results. I was in disbelief. After suffering for so long, I can’t believe how much Dr. Smetana has done for me in such a short time. He truly changed my life for the better.”

Our esteemed team has helped thousands of patients with thumb injuries and chronic conditions regain function and eliminate—or dramatically reduce—day-to-day pain, and we can help you, too. 

Come see us at IHTSC for any worrisome or persistent thumb pain. Call (317) 875-9105 or schedule online to book an appointment with a specialist.

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