Campbell's 1955 case series coins the term 'gamekeeper's thumb' to describe chronic ulnar collateral ligament insufficiency of the thumb MCP joint. The injury results from repetitive occupational radial stress, not acute trauma. The paper defines the mechanism, two pathological forms, and the disconnect between objective laxity and patient symptoms.
A patient with thumb MCP ulnar-side instability and no history of acute trauma is not a diagnostic puzzle — this paper tells you exactly what happened.
When occupational history reveals repetitive radial loading of the thumb, the diagnosis is chronic UCL attenuation, not an acute Stener lesion. The treatment implication matters: a chronically attenuated ligament may not be repairable primarily and may require reconstruction, unlike the acute avulsion that dominates the skier's thumb conversation.
Do not be misled by absent symptoms. Stress-test the thumb MCP joint in any patient with a relevant occupational history and document the laxity whether or not they complain. Two-thirds will not volunteer anything.
This paper draws the conceptual boundary every hand trainee must own: gamekeeper's thumb (chronic attenuation, no trauma) is a fundamentally different pathology from skier's thumb (acute traumatic rupture, often with Stener displacement), and getting this distinction right changes your operative plan.
Campbell's 1955 case series coins the term 'gamekeeper's thumb' to describe chronic ulnar collateral ligament insufficiency of the thumb MCP joint. The injury results from repetitive occupational radial stress, not acute trauma. The paper defines the mechanism, two pathological forms, and the disconnect between objective laxity and patient symptoms.
A patient with thumb MCP ulnar-side instability and no history of acute trauma is not a diagnostic puzzle — this paper tells you exactly what happened.
When occupational history reveals repetitive radial loading of the thumb, the diagnosis is chronic UCL attenuation, not an acute Stener lesion. The treatment implication matters: a chronically attenuated ligament may not be repairable primarily and may require reconstruction, unlike the acute avulsion that dominates the skier's thumb conversation.
Do not be misled by absent symptoms. Stress-test the thumb MCP joint in any patient with a relevant occupational history and document the laxity whether or not they complain. Two-thirds will not volunteer anything.
This paper draws the conceptual boundary every hand trainee must own: gamekeeper's thumb (chronic attenuation, no trauma) is a fundamentally different pathology from skier's thumb (acute traumatic rupture, often with Stener displacement), and getting this distinction right changes your operative plan.