Thumb UCL Repair Info Evidence Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific injury. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your thumb, and arrange imaging where it is needed.
This operation repairs the ulnar collateral ligament of the thumb. That is the strap of tissue on the inner side of your thumb that stops it bending too far sideways. It is usually torn by a fall onto an outstretched hand or a blow that forces the thumb away from the hand. We usually try a splint or cast first. A complete tear often fails to heal this way, so surgery is recommended when the ligament is fully torn or the thumb stays loose after a period of splinting. The aim is a stable, pain-free thumb that you can use for gripping and everyday tasks.
Before the operation
In the days before surgery your surgeon will confirm which imaging is needed to plan the operation. This may include an X-ray, an MRI scan, or an ultrasound of your thumb. You will be given instructions about fasting: nothing to eat for seven hours before your arrival time. We ask for seven rather than six so you can be brought forward if the theatre list runs early. You may be told to stop some of your usual medicines for a short time; your surgeon will give you exact instructions. Bring a list of everything you take. Arrange a lift home, as you will not be able to drive yourself. Wear loose, comfortable clothing. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.
On the day
You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist, the doctor who puts you to sleep and keeps you comfortable during the operation. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.
When the operation is finished, you wake up in the recovery area. Nurses stay with you while the anaesthetic wears off and check that you are comfortable. Once you are stable, you either go to a ward or go home the same day, depending on the procedure and how your recovery is going. If you are going home, you will need the lift you arranged earlier, as you will not be able to drive yourself.
What the operation involves
Your surgeon makes a cut over the side of your thumb where the ligament sits. Through this cut they find the torn ends of the ulnar collateral ligament, the strap of tissue that stops your thumb bending too far sideways. If the ligament has been pulled away from the bone, your surgeon reattaches it to its normal spot on the bone. Small anchors placed in the bone hold the stitches that secure the ligament back in place. The repair is done at the ligament's natural attachment point, because this keeps the normal range of movement in the joint at the base of your thumb.
If a small piece of bone has been pulled off with the ligament, your surgeon may hold that fragment in place with a small plate that hooks over the edge of the bone. Sometimes a pin is placed across the joint at the base of the thumb for extra protection while the ligament heals. In some repairs, a band of strong suture material is added alongside the mended ligament. This adds strength to the repair and can allow earlier movement of the thumb afterwards.
If the ligament has been torn for some time and has shrunk back, it may not be possible to stitch the ends together. Your surgeon can then rebuild the ligament using a nearby tendon, or use a substitute material to bridge the gap. The cut is closed with stitches and covered with a dressing. You will leave theatre with your thumb supported in a cast or splint, which protects the repair while it heals.
After the operation
When you wake up you will be in the recovery area, and nurses will stay with you while the anaesthetic wears off. Your thumb will be in a cast or splint, with dressings over the wound. We give you pain relief to keep you comfortable; tell the nurses if the pain is not settling. You can get up and move around as soon as you feel able, and someone should stay with you for the first 24 hours. Your team will tell you whether you go home the same day or stay one night in hospital. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.
Recovery
For the first few days your thumb will be sore and swollen. This settles gradually. Keeping your hand raised on a pillow, especially when resting or sleeping, helps ease the swelling. Take the pain relief we give you as directed, and tell us if it is not working.
You will leave hospital with your thumb in a cast or splint. This protects the repair while it heals, so keep it dry and use your other hand for tasks like dressing and preparing meals. We leave the dressing on for about 10 days and change or remove it when we see you. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby will guide your exercises and make any splint you need as your thumb heals.
Movement returns in stages. At first you may only be able to move the tip of your thumb. As the swelling settles and the repair strengthens, you will practise gripping and pinching in therapy. Everyday tasks like holding a cup or turning a key get easier as your grip returns without pain.
Once your surgeon is happy the ligament has healed, you will be gradually allowed back to work and sport. Athletes treated with this type of repair have returned to play quickly and at the same level of activity they had before the injury. Some people need longer than others, and your timeline may differ; your surgeon and your hand therapist will guide you.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Sometimes the repaired ligament can be injured again, especially if the thumb was loose for a long time before surgery. You might feel a sudden give or pop in your thumb, with fresh pain where the repair sits. Tell us straight away if this happens.
A nerve on the back of the thumb runs close to the operation site. If it is irritated during surgery, you may feel a tender, burning spot that is sore to touch, sometimes with sharp shooting pains. Bring this up at your next review so we can help settle it.
Any wound can become infected. Watch for redness that spreads out from the cut, warmth, swelling that gets worse rather than better, or a deep throbbing pain that does not ease with simple painkillers. You may see fluid or pus leaking from the wound, or feel feverish. Call the clinic if you notice any of these signs.
The small anchors holding the stitches in the bone can occasionally cause irritation. This usually feels like aching or tenderness over the bone at the base of your thumb, especially when you grip or pinch. Mention it at your review; it often settles, but sometimes the anchors need attention.
Some people notice mild aching in the thumb joint when they pinch or grip, even after the ligament has healed. Others find the thumb does not bend quite as far as before, most often at the joint at the base and the joint in the middle. These changes are usually slight. Raise them at your review so your therapist can work on them with you.
A few people find their pinch strength is a little less than in their other thumb once everything has healed. Hand therapy can help you build back as much strength as possible.
The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you notice spreading redness around the cut, fluid or pus leaking from it, or you feel feverish. Call us if your pain keeps getting worse instead of settling. Go to emergency if you have sudden severe pain, swelling in your calf, or shortness of breath. Go to emergency if your thumb or hand goes numb, changes colour, or you cannot move it at all. If you feel a sudden give or pop in your thumb with fresh pain, tell us straight away.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Overview
- Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results [2].
- The technique of thumb ulnar collateral ligament repair using suture anchors and suture tape augmentation preserves native ligament proprioception [1].
- The technique of thumb ulnar collateral ligament repair using suture anchors and suture tape augmentation provides additional stability during early healing phases [1].
Anatomy & Pathophysiology
Thumb Anatomy & Function
- The thumb has a more proximal and lateral position than the other digits, allowing movement inward and outward from the palm [4].
- The thumb ray is the shortest of the five rays of the hand and is clearly separated from the fingers [4].
- The web space of the thumb is the largest and deepest of the hand's web spaces [4].
- The thumb is described as the master digit of the hand, representing the dominant element that gives value to all other digits [9].
- The thumb metacarpal is independent and articulates with the trapezium [9].
- The thumb ray has considerable mobility and independence, which is greater than that of the fifth ray and the other fingers [9].
- The thumb possesses two phalanges, whereas the other digits have three [4].
Vascular Anatomy
- The "princeps pollicis" artery is the terminal branch of the radial artery that crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone [10].
- In the classical layout, the princeps pollicis emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [10].
- At the metacarpophalangeal joint level, the princeps pollicis divides into two terminal rami known as the collateral palmar arteries of the thumb [10].
- The collateral palmar arteries run along the digital tunnel symmetrically and are of equal caliber [10].
- The collateral palmar arteries head distally to finally unite in the pulp arcade [10].
- Only 15% of anatomical dissections of the thumb's palmar arteries fall into the classical "typical" category [10].
- In the second segment of the thumb (between metacarpophalangeal and interphalangeal creases), the main artery is the ulnar collateral artery [10].
- The ulnar collateral artery is more often easier to dissect than the radial collateral artery and its size enables a more reliable microanastomosis [10].
- A subtendinous anastomosis situated at the level of the neck of the first phalanx acts as a moderator between the two collateral arteries [10].
- In cases where the palmar ulnar collateral artery is absent, the dorsal artery takes its place by means of a branch through the subtendinous arcade [10].
- In the pulp segment, the two arteries are of similar size and run through the thick fatty subcutaneous padding [10].
- The dorsal arteries of the thumb originate from the palmar arteries (princeps, commissural, or anastomoses of the superficial arcade) at the level of the first metacarpal [10].
- The ulnar dorso-collateral artery generally stems from the "princeps pollicis" onto the medial border of the neck of the first metacarpal [10].
Cutaneous Anatomy
- The palmar surface of the hand forms a cutaneous unit extending from the distal transverse crease of the wrist up to the transverse crease at the base of the digits [5].
- The oppositional crease of the thumb constitutes the oblique axis of the hand and subdivides the palmar integument into two separate zones [5].
- The skin of the radial portion of the palm covers the thenar eminence and is relatively well vascularized and mobile [5].
- The skin of the ulnar and distal portion of the palm covers the hypothenar eminence where the skin has poor mobility [5].
- The central triangular part of the palm has fixed, poorly vascularized skin that covers almost directly the superficial palmar aponeurosis [5].
- The integument of the palmar face of the thumb is subdivided into phalangeal units separated by two digital flexion folds [5].
- When a digit is completely flexed, the integument of adjacent phalanges comes into contact in the zones of the flexion creases, establishing areas of cutaneous contact in the form of a diamond [5].
- The sides of the diamond-shaped cutaneous contact zones do not undergo variations in length during movements of flexion and extension [5].
- Incisions made along the lines of the diamond-shaped cutaneous contact zones present a minimal chance of retraction [5].
- The palmar surface of the thumb web is flat and precipitously interrupted, with skin densely adherent to the commissural skeleton [5].
- The commissural skeleton of the thumb web is formed by the distal transverse ligament, which is by far the deepest and the most mobile [5].
- The necessary skin to cover the thumb distal to the metacarpophalangeal joint is about 9 cm wide and 8 cm long [8].
- Skin loss of the thumb and first metacarpal requires a graft or flap of 13 cm wide and 12 cm long [8].
Surgical Approach Considerations
- Distal palmar incisions are transverse, while proximal palm incisions tend to be more longitudinal with the distal end curving radially [11].
- Incisions in the more proximal palm should parallel the thenar crease [11].
- The most important structure in the thenar area is the recurrent branch (motor) of the median nerve, which should be exposed and protected if its exact location is in doubt [11].
- Anatomic studies show that there is no single longitudinal incision in the proximal palm that completely avoids the palmar cutaneous branches of the median and ulnar nerves [11].
- Midlateral incisions suitable for fingers are also suitable for the thumb, with the radial side being more accessible [11].
- A radial midlateral incision on the thumb can be extended by curving its proximal end at the midmetacarpal area and creating a flap on the palmar surface [11].
- Care should be taken to avoid the dorsal branch of the superficial radial nerve to the radial side of the thumb during midlateral incisions [11].
Pathophysiology & Repair Outcomes
Investigations
- Clinical evaluation of the injured or dysfunctional hand and wrist requires combining patient history with a careful physical examination to pinpoint or narrow the scope of possible pathologic processes [3].
- Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [3].
- A careful physical examination is essential to direct care and future testing if indicated [3].
Treatment
- Thumb UCL repair using suture anchors and suture tape augmentation preserves native ligament proprioception [1].
- Thumb UCL repair using suture anchors and suture tape augmentation provides additional stability during early healing phases [1].
- Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective functional results [2].
- Acute surgical repair of the torn ulnar collateral ligament can achieve good objective functional results [2].
Complications
- Suture anchor and suture tape augmentation preserves native ligament proprioception [1].
- Suture anchor and suture tape augmentation provides additional stability during early healing phases [1].
Recovery
- Suture anchor and suture tape augmentation techniques preserve native ligament proprioception [1].
- Suture anchor and suture tape augmentation techniques provide additional stability during early healing phases [1].
Key Evidence
- [L5] The technique preserves native ligament proprioception while providing additional stability during early healing phases. [1] (10.1016/j.eats.2025.103957)
- [L4] Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results. [2] (10.1016/0020-1383(94)90179-1)
References
[1] Thumb Ulnar Collateral Ligament Repair Using Suture Anchors and Suture Tape Augmentation. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103957
[2] Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Injury. 1994. DOI: 10.1016/0020-1383(94)90179-1
[3] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.
[4] Exam Of The Hand Wrist 2Ed. INTRODUCTION.
[5] Exam Of The Hand Wrist 2Ed. Functional cutaneous units.
[8] Exam Of The Hand Wrist 2Ed. Planning skin cover of the hand and forearm.
[9] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.
[10] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.
[11] Campbell S Operative Orthopaedics 4 Volume Set. RESULTS OF SUTURE OF THE SCIATIC NERVE > PALMAR INCISIONS.
