COMMON HAND AND WRIST INJURIES IN STRIKING SPORTS – PART 6 – Thumb ligament injury

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A common joint injury observed in boxing is a tear of the ulnar collateral ligament (ULC) of the 1st ray metacarpophalangeal joint, the ligament that lies on the inside of the thumb (1). This ligament is often damaged when the thumb is caught and bent back during punching or defending. This is commonly referred to as a “skiers thumb” (when occurring acutely), or a “gatekeepers thumb” (when occurring chronically).
 
Athletes will often report localised pain around the thumb, particularly with bending the thumb back, and will typically have difficulty gripping.
 
Less severe cases of this injury can be managed with 4-6 weeks of immobilisation in a splint, followed by a graded strengthening program, particularly focusing on grip strength. Joint mobilisation may also be useful for less severe UCL injuries, with mobilisation of the thumb in the opposite direction to the direction of the injury often effective in reducing pain and improving function.
 
The risk with this type of injury is the development of a stener lesion, where the aponeurosis (a sheet of connective tissue that acts as an anchor) of the adductor pollicis (thumb muscle) becomes caught between the two ends of the ligament, and prevents healing of the ligament (2). This will often result in a lump on the inside portion of the thumb. In these cases, immobilisation of the joint will not allow for full recovery and surgery is required.
 
1. Noble C. Hand injuries in boxing. Am J Sports Med. 1987;15(4):342–346.
2. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 2010;20(2):106–112.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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