Diagnosis Explanation:

Gamekeeper’s thumb, also called Skier’s thumb, is an injury to the ulnar collateral ligament (UCL) of the thumb's metacarpophalangeal (MCP) joint. This ligament stabilizes the thumb during gripping and pinching movements. Injury typically occurs from a fall onto an outstretched hand (FOOSH), forced thumb abduction, or repetitive stress.

Types of UCL Injuries:

• Grade 1 (Mild Sprain): Ligament is stretched but intact; mild pain and swelling.
• Grade 2 (Partial Tear): Partial ligament tear with some joint instability.
• Grade 3 (Complete Tear): Ligament is fully torn; thumb may be unstable and require surgery.

Symptoms:

• Pain and swelling at the base of the thumb.
• Weak grip and difficulty pinching (holding objects, buttons, zippers, writing, etc.).
• Bruising and tenderness along the inside of the thumb.
• Thumb instability (feels loose when gripping).

Specific Work Modifications:

• If your job involves typing or writing: Use ergonomic pens, voice dictation software, and hand splints as needed.
• If your job requires manual labor: Avoid gripping tools or lifting heavy objects with the affected hand.
• If your job is desk-based: Keep the thumb supported with a brace, take breaks every 30 minutes, and avoid excessive mouse/keyboard use.
• Avoid: Forceful pinching, repetitive gripping, and prolonged use of the thumb.

Specific Activity Modifications:

• If you play sports: Avoid racket sports, skiing, baseball, and basketball until cleared for return.
• If you do weightlifting: Avoid gripping-heavy exercises (deadlifts, pull-ups, kettlebells, dumbbells).
• If you do crafting, gardening, or cooking: Use adaptive tools with larger handles to reduce thumb strain.
• Avoid: Activities requiring forceful thumb use, twisting motions, and excessive pressure on the injured ligament.

Recommended Supplements:

• Collagen Peptides – 10g daily for ligament and joint repair.
• Vitamin C – 500mg daily to support collagen synthesis.
• Glucosamine & Chondroitin – 1500mg/1200mg daily for joint lubrication and ligament health.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Turmeric (Curcumin) – 500-1000mg daily for pain relief.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, tofu, eggs) to support ligament healing.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain joint lubrication.
• Limit Processed Foods & Sugars to prevent inflammation.
• Hydration: Drink 8-10 cups of water daily to support joint function.

Home Exercise Prescription (Rehabilitation for Gamekeeper’s Thumb)

Early Phase (0-2 Weeks, Protecting the Joint & Reducing Pain):

• Thumb Spica Splinting – Wear a thumb splint (spica splint) full-time for 4-6 weeks to allow healing.
• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression, Elevation.
• Passive Thumb Stretching – Use the opposite hand to gently move the thumb in small pain-free motions, 10 reps, 2x/day.

Strengthening Phase (2-6 Weeks, Improving Stability & Function):

• Isometric Thumb Press – Press thumb against index finger without moving, hold 5 seconds, repeat 10 reps, 2x/day.
• Rubber Band Thumb Extensions – Wrap a rubber band around fingers, open the thumb against resistance, 10 reps, 2x/day.
• Towel Grip Exercise – Squeeze a rolled towel using thumb and fingers, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Preventing Recurrence & Restoring Function):

• Thumb Opposition Drill – Touch thumb to each fingertip, 10 reps, 2x/day.
• Grip Strengthening (Soft Ball Squeeze) – Squeeze a soft ball 5 seconds, repeat 10 reps, 2x/day.
• Wrist Strengthening (Light Resistance Band) – Strengthen wrist and forearm muscles to prevent re-injury, 10 reps, 2x/day.

Helpful Books:

1. The Hand and Wrist Pain Solution: Simple Exercises for Relief – Dr. Ross Clifford.
2. Arthritis and Hand Therapy: A Self-Help Guide to Managing Joint Pain – Susan J. Barnhart, PT.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.