UCL Injuries of the Thumb in Athletes

By Brittney Lang, MS, ATC, SCAT
Athletic Trainer
MUSC Health Sports Medicine

Injuries to the ulnar collateral ligament (UCL) of the thumb are a common occurrence in sports especially those with contact. These injuries can be minor to severe, and the recovery can be weeks to months long. There are different treatment methods for the injuries depending on the severity of the injury.

Most UCL injuries are caused when an athlete's thumb is pulled away from the palm of the hand or they fall on it with an outstretched thumb. This puts an excessive force on the joint and ligament and stretching it beyond its normal limits. This action can cause pain, weakness, decreased range of motion and other possible symptoms. The thumb can feel unstable after an injury and cause an athlete not to perform well. If an ulnar collateral ligament injury of the thumb is suspected the athlete should seek further medical evaluation by an orthopedic surgeon for diagnosis and treatment.
There are a couple different types of UCL injuries seen with athletes: sprain or tear - with or without a fracture. A UCL sprain is an injury that stretches the connective tissue and can cause some tearing of the ligament and can be graded on its severity. A UCL tear of the ligament can be partial or a full tear of the tissue and this can sometimes include a fracture. A UCL tear can possibly need to be repaired through surgery. Common symptoms of an ulnar collateral ligament injury of the thumb can consist of:

• Pain usually at the base of the thumb around the metacarpal phalangeal (MCP) joint. Can increase with movement.
• Swelling and bruising of the MCP joint and hand
• Can feel unstable with testing
• Grip weakness of the thumb
• Tenderness to the touch on the inside of the thumb at the MCP joint

The athlete will need to be evaluated by an athletic trainer or other health care professional and if needed referred to an orthopedic surgeon for further diagnosis and treatment. The athlete may need x-rays and MRI to determine the severity of the injury. Depending on type of UCL injury there could be multiple treatment options for the athlete's recovery.

Once an UCL injury has been diagnosed a treatment plan with be determined. Treatment options can vary depending on type and severity of the injury as well as sport and position the athlete participates in at the time. The athlete may only be placed in a thumb brace for support or cast and have to rest and recover for a few weeks. Physical therapy may be prescribed as well for recovery. The athlete may be allowed to continue to play sports with the use of the brace or cast as well depending on sport and position. Rest, ice, and compression will be used for treatment. They may be prescribed non-steroidal anti-inflammatory medications to reduce pain and inflammation.

For UCL tears/fractures or severe sprains the athlete may need to have surgery to repair the ligament and/or the fracture if present. This will have a longer recovery time and will usually be placed into a cast or thumb splint to restrict movement. They will require physical therapy to regain hand and grip strength and range of motion of the thumb. The athlete will also be prescribed rest, ice, and compression to reduce pain and swelling. They will be given non-steroidal anti-inflammatory medication as well.

After the athlete has recovered and is cleared by their athletic trainer, orthopedic surgeon, or other healthcare professional they can start to return to their sport. The athlete may need to wear a brace, thumb support or tape in the future to limit the risk of further injury. If the athlete has any issues or concerns with returning to sport, they should address them with their healthcare professional. UCL injuries of the thumb are common in athletics and many athletes will sustain an injury during their time in sports.