Thumb Ulnar Collateral Ligament (UCL) Injury
What is the Thumb UCL?
The ulnar collateral ligament (UCL) is a strong band of tissue on the inside of the thumb, at the middle joint of the thumb (the knuckle where the thumb meets the hand). Its job is to keep the thumb stable during pinching and gripping, and prevents the thumb from bending too far away from the hand.
What are some of the causes of a UCL thumb injury?
Most injuries happen when the thumb is forcefully bent outward (abducted). This forceful motion outward can be due to falls onto an outstretched hand (skiing, snowboarding, cycling), sports injuries (basketball, football, rugby, martial arts), direct blow to the thumb, or repetitive stress (chronic injury known as Gamekeepers Thumb).
What are the symptoms of a UCL thumb injury?
Symptoms depend on severity (sprain vs tear). A mild-moderate injury can cause pain on the inner side of the thumb, swelling and tenderness at the thumb base, pain when gripping, pinching, or twisting, and reduced thumb strength. In a more severe injury or a complete tear, you could experience significant swelling and bruising, thumb instability (feeling loose or weak), inability to pinch firmly (holding keys or paper), and you may palpate a small lump in the area (possible Stener lesion).
How are UCL thumb injuries diagnosed?
A physician may diagnose a UCL thumb injury through a physical exam to assess stability, X-ray to rule out avulsion fracture, or an MRI or ultrasound to confirm partial vs complete tear and check for a Stener lesion.
What is the treatment for a UCL thumb injury?
For non-surgical treatment, partial tears/stable injuries, treatment may include
- Immobilization in a splint or custom orthotic for 4–6 weeks
- Use of ice for pain and edema management
- Avoiding gripping or pinching
Surgery would be indicated by a physician if there is a complete tear, a Stener Lesion, or thumb instability.
Rehabilitation & Recovery (Surgical option)
If surgery is required, the rehabilitation will be completed in 4 phases. Phase one includes thumb immobilization, maintaining non-impacted joint motion, and reducing pain and swelling for the initial 4 weeks dependent on the surgeon’s preference. You may be able to move sooner. Your surgeon/hand therapist will guide you through the process based on stability and surgical repair. During phase 2 (weeks 4–6), gentle thumb range-of-motion exercises may be implemented, with restriction of forceful pinching. During this phase, you will be cleared to complete light functional use, such as folding laundry or grooming tasks. Weeks 6-10 are classified as phase 3. Initiation of pinch strengthening (i.e. therapy putty, rubber bands), grip exercises, and proprioception/coordination training will be completed. Phase 4 is classified as the “Return to Sport/Work” (8–12+ weeks). Sport and work-specific drills will be completed as well as review of protective taping or brace initially.
Rehabilitation should be completed under the supervision of a specialized hand therapist to ensure correct progression and to protect healing structures. Full recovery for a partial tear can take between ~6–8 weeks. Surgical repair may take ~10–12+ weeks.
The rehabilitation process and timeline will vary based on multiple factors such as instability, delayed healing, or other guidelines from the surgeon. It is important that you see a therapist that specializes in Orthopedic care of the Upper Extremity such as a Certified Hand Therapist, to ensure proper progression through the rehab process to avoid re-injury.
