What is a ulnar collateral ligament injury of the thumb?

Figure 1: Thumb Pain - UCL Injury - Physio Frenchs Forest, Physio Macquarie Park

What is the anatomy of the ulnar collateral ligament of the thumb?

The anatomy of the ulnar collateral ligament (UCL) of the thumb is a complex structure that provides stability to the joint and helps to prevent excessive motion. The UCL is composed of three distinct components: an anterior band, a posterior band, and a transverse band. The anterior and posterior bands are located on either side of the metacarpophalangeal joint (MCPJ), while the transverse band connects them together. All three components work together to provide stability to the MCPJ, allowing for normal range of motion in the thumb.

Ulnar collateral ligament (UCL) injuries of the thumb are typically caused by overstretching or tearing of the ligament due to repetitive stress or trauma. This type of injury is common in athletes who participate in sports such as baseball, basketball, volleyball and skiing. UCL injuries can also occur when a person falls on an outstretched hand or when a direct blow is applied to the thumb.



What are the signs and symptoms of a UCL injuries?

  • Pain on the inside of the thumb

  • Swelling of the thumb

  • Decreased range of motion in the thumb joint

  • Possible avulsion fracture on x-ray

  • MRI evaluation is the gold standard to evaluate if the ligament is torn or not

  • A palpable nodule may be felt to diagnose a stenar lesion

 

Figure 2: Thumb Pain - UCL Injury - Physio Frenchs Forest, Physio Macquarie Park

When is surgery indicated for an ulnar collateral ligament injury?

The UCL normally lies deep to the adductor pollicis tendon. Stener lesion is a type of injury to the ulnar collateral ligament (UCL) in which one end of the torn UCL slips and gets trapped under the adductor aponeurosis/adductor pollicis muscle, thus creating a gap between the ligament and the metacarpophalangeal (MCP) joint. This prevents healing and is an indication for surgical repair.

If there is a large avulsion fracture where the ligament has pulled a large piece of the bone, then a surgical procedure may be required to repair both the ligament and bone.

 

Figure 3: Thumb Pain - UCL Injury - Physio Frenchs Forest, Physio Macquarie Park

What is the conservative treatment for ulnar collateral ligament injuries of the thumb?

Treatment for this type of injury may involve rest, immobilization with a splint or cast for 4-6 weeks. The thumb will then require hand therapy to regain the range of motion and strength.

  

How long should you avoid sport?

Typically patients recovering from a stenar lesion should avoid sport for 8-12 weeks. This large depends on the severity of the tear and the progress in hand therapy.

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Reece JonesUCL, UCL injury, Ulnar collateral ligament injury, hand therapy, physio for thumb pain, thermoplastic splint, frenchs forest, macquarie park, physiotherapy