(UCL) Ulnar Collateral Ligament Injuries of the Thumb

Ligament Injuries Conditions Ligament Injuries Ulnar Collateral Ligament Injuries of the Thumb


Ulnar collateral ligament injuries of the thumb are the most common ligament injuries of the hand. This is because the thumb is positioned in a different plane than the rest of the fingers and becomes vulnerable to falls or participation in ball sports. The stability of the thumb relies on the ulnar collateral ligament situated at the MCP joint, where the thumb meets the hand. The thumb is supported at the MCP joint by a ‘sling’ or two intrinsic muscles, namely the abductor policies brevis and adductor pollicis on the ulnar side. At this level, the ulnar collateral ligament provides the ability for a strong pinch action or tip-to-tip pinching.

UCL injuries of the thumb typically occur when there is a forceful hyperextension or sprain of the thumb, often due to activities like skiing, playing sports, or falling on an outstretched hand. The injury can range from a mild sprain or grade one injury to a complete tear of the UCL and is sometimes even associated with a capsular tear of this joint. Usually, the ligament tears off at its attachment, or it can avulse a small piece of bone (called an ulnar collateral ligament avulsion fracture). Furthermore, the ligament might detach distally from its dorsal capsule with the volar plate, which then assumes a different angle, still creating instability due to rotation instability. This is probably the most common in a grade 2 type injury where the ulnar collateral ligament tears open, but there is some form of soft tissue that restricts the complete opening of the joint.

In the most advanced lesions, the ligament tears completely, as in a grade 3 injury, which is called the Stener lesion. This means that the ligament stump sits between the bone and the adductor pollicis muscle, an intrinsic muscle that prevents the ability of the stump to heal by itself.


The treatment of ulnar collateral ligament injuries of the thumb depends on the grade or degree of injury. In acute injuries, we often try conservative treatment first, with splinting for 4-6 weeks. In more severe injuries, namely grade 3 injuries, where there is complete instability, it is best to reconstruct the ligament and repair it as soon as possible.

In the acute setting, this injury is called a skier’s thumb. This is because it is a common injury in skiers, as the ski pole pushes the thumb in a radial direction when skiers fall. In the more chronic setting, it is called a ‘game keeper’s thumb’, and in this case, the reconstruction requires more than just a repair and might need a tendon graft to reconstruct the ligament.

Prompt and appropriate treatment of an ulnar collateral ligament injury is essential to ensure proper healing and the restoration of stability of the joint and, ultimately, of thumb function.


1Does it take long to recover from a UCL injury?
Recovery depends on the severity of the injury. For example, for a mild UCL injury, a full recovery can take several weeks and a complete tear will require surgery and 3-4 months recovery.
2Will a UCL tear heal without surgical intervention?
If the tear is minor, there is a strong possibility it may heal independently.
3Is a UCL injury serious?
A torn ulnar collateral ligament (UCL) leads to thumb MCPJ instability, thumb pain and loss of hand function.

Please read the above text for more in-depth information to help answer these questions. It's important to consult with our qualified healthcare professionals to ensure the appropriate diagnosis and treatment plan for your specific situation.