Ulnar Collateral Ligament Injury of the Thumb

ExitCare ImageUlnar collateral ligament (UCL) injury occurs when the UCL ligament at the base of the thumb is stretched or torn. The UCL ligament is important for normal use of the thumb. This ligament helps in motions, such as grabbing or pinching. Sprains are classified into 3 categories:

  • Grade 1 sprains cause pain, but the tendon is not lengthened.

  • Grade 2 sprains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be diminished.

  • Grade 3 sprains are marked by a complete tear of the ligament. The joint usually displays a loss of function.

SYMPTOMS

  • Pain, tenderness, bruising, swelling, and redness at the base of the thumb, starting at the side of injury, that may progress to the whole thumb and even hand with time.

  • Impaired ability to grasp or hold things soon after injury.

CAUSES

A UCL injury is caused by forcefully moving the thumb past its normal range of motion. This most commonly occurs when falling onto outstretched hands, while holding on to a ski pole, or in baseball (when making an awkward catch). Normally, the UCL prevents the thumb from straightening the thumb towards the forearm or wrist.

RISK INCREASES WITH:

  • Previous thumb injury or sprain.

  • Skiing with ski poles.

  • Contact sports, especially catching sports (baseball, basketball, or football).

  • Sports in which the thumb may be pulled away from the rest of the hand.

  • Poor hand strength and flexibility.

PREVENTION

  • Learn and use proper technique when catching and/or when falling while skiing.

  • Taping, protective strapping, bracing, or other equipment can prevent the thumb from being pulled away from the rest of the hand.

  • Allow complete healing before returning to activities.

PROGNOSIS

The length of healing time depends on the severity of injury. In general:

  • Grade 1 sprains usually heal enough in 5 to 7 days to allow for modified activity. Grade 1 requires an average of 6 weeks to heal completely.

  • Grade 2 sprains require 6 to 10 weeks to heal completely.

  • Grade 3 sprains often require 12 to 16 weeks to heal, although surgery may be recommended.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, resulting in a chronic problem.

  • Injury to other structures (ie. bone, cartilage, or tendon).

  • Chronically unstable or arthritic thumb joint.

  • Prolonged disability, particularly inability to pinch, grasp, or grip with any strength.

  • Delayed healing or resolution of symptoms, particularly if activity is resumed too soon.

  • Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, or paralysis), looseness of the ligament and weakness of pinching, thumb stiffness, and pain.

TREATMENT

Treatment initially consists of ice, medicine, and compressive bandaging to help reduce pain and inflammation. The thumb and wrist should be restrained (immobilized) to allow for healing. If the tear is complete, then surgery is often necessary to repair the damaged ligament.

MEDICATION

  • If pain medicine is necessary, then nonsteroidal anti-inflammatory medicine, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be prescribed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Pain, swelling, or bruising worsens despite treatment.

  • You experience pain, numbness, discoloration, or coldness in the hand or thumb.

  • After surgery you develop fever, increasing pain, redness, swelling, drainage or bleeding, or increasing warmth.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).