Treatment of Gamekeeper's thumb
Once gamekeeper's thumb has been diagnosed, the injury will require immediate treatment, either invasive or noninvasive based on the severity of the injury.
Noninvasive Treatment
Ulnar collateral ligament strain or partial tears can be treated with noninvasive methods. As with most injuries, icing is recommended for 15 - 20 minutes per session to reduce swelling; however, after 48 hours post injury, the effectiveness of icing decreases (8). Additionally, a splint or cast should be used to immobilize the injured joint for four to six weeks. After, the patient should seek a physical therapist to help restore normal function of the joint.
Invasive Treatment
If a complete tear of the ulnar collateral ligament is suspected, the patient will undergo outpatient surgery to repair the damaged ligament. The superficial radial nerve will be blocked and an incision will be made on the ulnar side of the thumb. The physician will then clean the damaged tissue and re-anchor the UCL to its original insertion point. If there is a fracture as well, the physician will also insert pins to assure proper healing. The incision will then be closed and the patient will be able to leave the hospital the same day he or she arrived with a cast or splint to immobilize repaired injury (8). For additional clarity on the procedure, below is a video of the surgery. WARNING: the below video contains graphic imagery of the surgical repair of the ulnar collateral ligament.
Rehabilitation
Doctor of Physical Therapy, Joe Godges, provides four phases in which post-operation rehabilitation of gamekeeper's thumb should occur. Below is a summary of his recommendations:
Phase 1 (0 - 6 weeks)
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Phase 2 (6 - 8 weeks)
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Phase 3 (8 - 12 weeks)
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After the paitient has completed the first three phases, he or she may initiate Phase 4 of his/her rehabilitation process. Phase four includes unrestricted activity of the patient. Full range of motion should have been achieved and hand and wrist muscles should reach pre-injury strength. More details on Joe Godges work can be found at: http://xnet.kp.org/socal_rehabspecialists/ptr_library/04WristandHand%20Region/26Hand-ThumbUlnarCollateralLigamentRepair.pdf