Elbow, Wrist & Hand

What It Is

Gamekeeper's thumb is an injury to a ligament at the base of the thumb. The name comes from the surgeon who first described it, who noticed it in Scottish gamekeepers who killed rabbits by breaking their necks, which repeatedly strained the thumb (Madan et al., 2014). Gamekeeper's thumb is the long-term (chronic) form of the injury: repeated strain on the thumb over time gradually damages the ulnar collateral ligament (UCL) (AAOS, n.d.).

The same ligament can be injured suddenly, for example in a fall, and this is called skier's thumb (Madan et al., 2014). Today, most UCL injuries are of this sudden type. The thumb is forced away from the index finger, which stretches or completely tears the ulnar collateral ligament.

When the injury happens slowly from repeated strain, treatment can be more difficult, because the ligament gradually thins, making it harder to reattach if it tears.

UCL injuries can happen in any accident where the thumb is pulled backwards or sideways. Falling while skiing, with your hand strapped to a ski pole, is a classic cause (AAOS, n.d.). Athletes who use their hands are also at risk, including people who play ball sports that involve catching and throwing, such as basketball and volleyball, and contact sports such as rugby, football and wrestling, where force is applied to the thumb when grappling or tackling (AAOS, n.d.; Madan et al., 2014).

Gamekeeper’s or Poacher’s Thumb Anatomy

Gamekeeper's thumb is an injury to the UCL (ulnar collateral ligament), which is on the inside of the thumb at the MCP (metacarpophalangeal) joint, where the thumb meets the hand. The UCL keeps the thumb stable so you can pinch and grip objects (AAOS, n.d.). UCL injuries can be very painful and can cause loss of pinch strength and function (Madan et al., 2014).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Gamekeeper’s Thumb

After a period in a splint or cast, the thumb can be stiff, and stretching exercises to regain movement, followed by exercises to rebuild grip strength, are part of recovery (AAOS, n.d.; Madan et al., 2014). I can guide you through these, within any limits your doctor or surgical team sets. See the My Approach tab for how I work.

1. Ice

Apply a cold pack to the thumb for 20 minutes at a time, several times a day, to help reduce swelling. Never put ice directly on the skin (AAOS, n.d.).

2. Medication

OrthoInfo says that non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and swelling from a sprained thumb (AAOS, n.d.). (This medicine information comes from OrthoInfo (AAOS), not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.) If pain and swelling continue for more than 48 hours, see a doctor (AAOS, n.d.).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Splint or cast: a doctor may put the thumb in a splint or a thumb cast to keep it still while the ligament heals (AAOS, n.d.).
Surgery: for a severe sprain or a complete tear, an operation may be needed to reattach the ligament to the bone, for example with a pin, screw or small anchor, and to fix any small piece of bone that has been pulled off (AAOS, n.d.). Follow your surgical team's own instructions afterwards.

How I can help (see the My Approach tab)

Hands-on work for the hand, forearm and areas working harder
Stretching to ease stiffness after a splint or cast
Pinch and grip strengthening
Taping for your return to sport, and showing you how to do it yourself

Tips

After the injury, moving the thumb will be painful. Swelling at the base of the thumb may also be a sign of a problem.
When playing sport, take care when falling or colliding with another person.
Excessive force on the thumb can cause the injury.
If you notice bruising or swelling at the base of your thumb after an injury, have it checked by a professional (Madan et al., 2014).

Treatment

My Approach

The ligament at the base of your thumb needs protecting while it heals, but once the splint or cast comes off, the thumb is often stiff and weak. Your doctor or surgical team decides how long the thumb stays protected and when it can move and take load. I work inside those limits, and after surgery I need your surgeon's okay before any hands-on treatment of the hand.

If a small piece of bone was pulled off with the ligament, please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

While It's Protected

Work on the forearm, upper arm, shoulder and neck, which often tighten when one hand is out of action
Gentle lymphatic drainage above the splint to help swelling clear, and keeping the hand raised
Keeping the fingers, wrist and elbow moving where your team allows, and I'll show you how to use wrapped ice safely at home

Once It's Out of the Splint

Gentle work around the thumb and hand; after a repair, gentle work along the ligament rather than cross-fibre frictions
Warm applications and gentle stretching to ease stiffness
Gentle joint mobilisation for a stiff thumb, but not on a joint that is still loose and hasn't been repaired; there we focus on strength instead
Pinch and grip strengthening, building to the demands of your work or sport
Taping to protect the thumb when you return to sport, and I'll show you how to tape it yourself

If the thumb feels unstable or gives way when you pinch, see your doctor.

What to Expect

Typical Course

Typical course: Most people spend around 4 to 6 weeks in a splint or cast, and getting full movement and grip strength back usually takes a further 1 to 3 months, following your team's plan. Once you're out of the splint, visits are usually once or twice a week at first, then weekly, then spaced out as you manage more at home.

What I Focus On

Working Within Your Team's Limits

Forearm & Hand Release

Thumb Mobility

Pinch & Grip Strength

Safe Return to Sport

Sources

References

Madan, S.S., Pai, D.R., Kaur, A. and Dixit, R. (2014) 'Injury to ulnar collateral ligament of thumb', Orthopaedic Surgery, 6(1), pp. 1–7. doi: 10.1111/os.12084
American Academy of Orthopaedic Surgeons (n.d.) Sprained thumb. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/sprained-thumb/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooGamekeeper's or Poacher's Thumb

What It Is

Gamekeeper’s or Poacher’s Thumb Anatomy

Self-Care & Treatment

How to Treat Gamekeeper’s Thumb

1. Ice

2. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Protected

Once It's Out of the Splint

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooGamekeeper's or Poacher's Thumb

What It Is

Gamekeeper’s or Poacher’s Thumb Anatomy

Self-Care & Treatment

How to Treat Gamekeeper’s Thumb

1. Ice

2. Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Protected

Once It's Out of the Splint

Typical Course

References

Related Conditions

Bennett's Fracture

Boutonniere Deformity of the Finger

Carpal Bone Fracture

Colles' Fracture

Book a session