From the Research
If you cannot bend or flex your thumb but can extend it after repeated traumas, you likely have gamekeeper's thumb, and the treatment plan should prioritize immobilization, rest, and potentially surgical repair to minimize morbidity, mortality, and improve quality of life. The condition, also known as skier's thumb, is an injury to the ulnar collateral ligament (UCL) of the thumb. Initial treatment typically involves immobilization with a thumb spica splint or cast for 4-6 weeks to allow the ligament to heal, as suggested by studies on similar injuries 1. During this time, resting the thumb, applying ice for 15-20 minutes several times daily to reduce swelling, and taking anti-inflammatory medications like ibuprofen or naproxen as needed for pain and inflammation are recommended.
After the immobilization period, physical therapy is crucial to restore range of motion and strength, including gentle stretching exercises, thumb opposition exercises, and grip strengthening. For severe tears or complete ruptures where the thumb cannot be stabilized with conservative treatment, surgical repair may be necessary, as indicated by the most recent and highest quality studies on the topic 2. The inability to flex your thumb while maintaining extension ability suggests ligament damage rather than tendon injury, as the extensor mechanism remains intact while the flexor function is compromised due to pain or instability from the damaged UCL.
Key considerations in the treatment plan include:
- Immobilization to allow the ligament to heal
- Rest and ice to reduce swelling and pain
- Anti-inflammatory medications for pain and inflammation
- Physical therapy to restore range of motion and strength
- Potential surgical repair for severe or complete ruptures
It's essential to prioritize the most recent and highest quality evidence when making treatment decisions, and in this case, the focus should be on minimizing morbidity, mortality, and improving quality of life for the patient 3, 4, 5.