Thumb UCL injury Info In-depth Evidence

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

• Surgical management of thumb ulnar collateral ligament (UCL) injuries produces overall favorable results [1].
• Untreated UCL injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [2].
• The rate of surgery for acute thumb metacarpophalangeal UCL injury varies based on patient characteristics and the individual treating surgeon [3].
• Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications [4].
• Major League Baseball players who underwent thumb UCL repair played in a similar number of games per season and had similar career lengths as controls [10].
• Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline [11].
• Patients with both acute and chronic thumb UCL injuries have similarly acceptable functional outcomes, postoperative pain, and satisfaction [13].
• Thumb UCL injuries can be safely and effectively managed by football position demands [14].
• Mini hook plate fixation could be an alternative treatment technique for thumb UCL avulsion fractures [15].
• The patient is placed in the supine position with a small bump on which to rest the thumb for open repair of the thumb UCL [16].
• The surgeon should position themselves between the shoulder and head to allow easier access to the ulnar aspect of the thumb [16].
• A lazy S approach is used on the ulnar aspect of the thumb for UCL repair [16].
• Careful identification of the radial sensory nerve is required, with prior documentation of sensibility [16].
• The adductor aponeurosis is incised on the ulnar side to allow repair after collateral ligament repair [16].
• The torn ligament is identified as distal off the phalanx, midsubstance, or proximal [16].
• Nonabsorbable suture with pullout button, bone anchors, or figure-of-eight imbrication of midsubstance repair are used for ligament repair [16].
• Motion is limited for the first 4 to 6 weeks depending on chronicity of the injury, with more chronic injuries immobilized longer [16].
• Guided therapy begins at 6 weeks in a removable splint [16].
• Treatment of a thumb UCL complete rupture (Grade III) using a custom-made hinged splint shows promise in the conservative management of compliant patients [20].
• Both pull-out sutures and bone anchor techniques are safe and effective for treating acute thumb UCL injuries [23].

Anatomy & Pathophysiology

Ligament Anatomy and Injury Patterns

• The ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is critical for effective pinch [25].
• Distal tears of the UCL at its insertion in the proximal phalangeal base are more common than proximal tears from the metacarpal [27].
• Ruptures within the substance of the ligament occasionally occur [27].
• The UCL ruptures off the base of the proximal phalanx [36].
• A tear of the distal insertion is most common, but intrasubstance tears and tears of the proximal portion can also occur [16].
• The anatomic attachment site for a distal avulsion of the UCL is 25% dorsal from the volar surface of the proximal phalanx [62].
• Moberg and Stener noted UCL injuries to be 10 times more common than radial collateral ligament (RCL) injuries [27].
• The mechanism of injury is sudden, forced radial deviation (abduction), often resulting from a fall on an outstretched hand with the thumb abducted [27].
• Snow skiing accidents and falls on an outstretched hand with forceful radial and palmar abduction of the thumb are the usual causes [28].
• In skiing, if a person falls while gripping the ski pole, the handle abducts the thumb [27].
• Most modifications in ski pole design, including elimination of the strap, have not been shown to substantially reduce the incidence of thumb injuries [27].
• Changes in ski pole design have been shown to reduce the incidence of this injury [28].
• Associated injuries include tears of the dorsal capsule and ulnar aspect of the volar plate and occasionally a rent in the adductor aponeurosis [27].
• Other injuries associated with tears of the ulnar collateral ligament include avulsion fractures, dorsal capsular tears, and volar plate tears [28].
• Most surgical injuries have associated dorsal capsule tears that may be interposed between the articular joint surfaces [26].

Stener Lesion Pathophysiology

• A Stener lesion is described when the ligament is completely torn and is retracted [7].
• The avulsed ligament, with or without a bony fragment, can become displaced above the adductor aponeurosis, preventing healing (the so-called Stener lesion) [36].
• In 25 of 39 patients with complete ruptures, Stener found the adductor aponeurosis interposed between the ruptured ulnar collateral ligament and its site of insertion on the base of the proximal phalanx [28].
• On clinical examination, a prominent lump can be palpated that represents the ulnar collateral ligament being proximally and superficially displaced by the adductor aponeurosis [28].
• The adductor aponeurosis interposition prevents direct ligament healing without surgery [25].
• If left uncorrected, a Stener lesion prevents proper healing and leads to chronic instability and subsequent arthrosis [28].
• The tear will not heal in the setting of a Stener lesion because of adductor aponeurosis interposition [25].
• When a Stener lesion is present, it appears as an edematous, rounded mass that may obscure the otherwise well-defined proximal border of the adductor aponeurosis [62].
• The radial-based abductor cannot create a Stener-type lesion [37].

Joint Biomechanics and Stability

• The MCP joint is generally examined by applying a radial force in extension and with approximately 30° of MCPJ flexion to relax the palmar plate, the latter thought to isolate the UCL proper [7].
• Physical examination is performed with a valgus stress applied in neutral rotation to the thumb in both extension (testing the accessory ligament) and 30° to 35° flexion (proper ligament) [25].
• The collateral ligaments of the thumb MP joint afford lateral stability but also resist volar subluxation [27].
• If one ligament is torn, the proximal phalanx tends to rotate volarly on the side of the tear, with the opposite intact ligament serving as the axis [27].
• In the case of an isolated UCL rupture, the proximal phalanx rotates in supination around the intact RCL [27].
• Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint [8].
• The metacarpophalangeal articulation is of a condylar type and is capable of small lateral movements, especially to the radial side [45].
• Flexion of the metacarpophalangeal articulation is always accompanied by radial deviation and pronation, thus stretching the ulnar metacarpophalangeal ligament [45].
• This stretching helps to ensure stability of this articulation, which is more important than movement from a functional viewpoint [45].
• A competent UCL is critical for effective pinch [25].

Diagnostic Findings and Thresholds

• More than 35° of laxity alone or more than 15° of laxity compared with the contralateral side has historically been considered a positive test result [25].
• New evidence suggests that a lack of definite end point rather than comparison with the uninjured side should be used to define complete UCL rupture [25].
• An injured thumb that shows more than 30 degrees of instability compared with the uninjured side indicates a complete rupture [28].
• If a hard endpoint is not encountered and there is increased deviation (>20 degrees) at the MP joint, surgery is recommended [22].
• Comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant variation between right and left thumbs [32].
• Ulnar collateral ligament retraction more than 3 mm and interposed soft tissue are reasonable guides to surgical intervention [28].
• Injuries that are unstable (usually 30° more opening with radial stress than the opposite uninjured side) are believed to have Stener lesions and are treated surgically [36].

Associated Fracture Patterns

• An avulsion fracture of the ulnar base of the proximal phalanx at the insertion of the ligament is most common [27].
• Typically, the fracture fragment is small and includes little of the articular surface [27].
• Fractures involving more than 10% of the articular surface can occur and may require fixation if they are displaced 2 mm or more and associated with articular incongruity [27].
• A minimally displaced (<2 mm) avulsion fracture signifies a complete avulsion without a Stener lesion [28].
• Avulsion fractures from the metacarpal head and intraarticular shearing fractures of the volar surface of the radial condyle of the metacarpal head have also been reported [27].
• A rare but potentially problematic fracture pattern involves a rupture of the UCL from the proximal phalanx and a simultaneous articular shear fracture of the proximal phalangeal base [27].
• If attention is directed solely to the shear fracture, a complete tear of the UCL might be missed [27].

Classification

• Acute thumb MCPJ UCL injuries represent a spectrum from minor 'sprains' to high-energy multiligament ruptures [7].
• Minor 'sprains' without joint instability on clinical examination are generally treated with early movement as pain allows [7].
• Complete UCL ruptures typically present with inability to load the MCPJ in pinch and joint instability on clinical examination [7].
• The term 'Stener lesion' describes a condition where the ligament is completely torn [7].
• 75% of cases with complete rupture of the ulnar collateral ligament of the thumb will fail to heal with conservative treatment [9].
• A 4-stage, treatment-oriented classification of thumb UCL injury is based on the degree of UCL displacement [19].
• The 4-stage treatment-oriented classification correlates with the likelihood of success with either immobilization or operative intervention [19].
• The presence of a displaced fleck sign has a high likelihood of a Stener lesion [18].

Clinical Presentation

Mechanism and Epidemiology

• Injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is referred to as skier’s thumb or gamekeeper’s thumb [25].
• Snowboarders may also injure a thumb during falls and turns [27].
• UCL injuries to the thumb are 10 times more common than radial collateral ligament (RCL) injuries [27].
• Acute injuries to the UCL of the thumb MCP joint are estimated to account for approximately 50 in 100,000 presentations to Emergency Departments in the United Kingdom [7].

Associated Injuries and Pathology

• Associated injuries include tears of the dorsal capsule and ulnar aspect of the volar plate [27].
• Occasionally, a rent in the adductor aponeurosis is associated with UCL injuries [27].
• Volar subluxation of the MCP joint may result from concomitant tears of the dorsal capsule and UCL [27].
• An avulsion fracture of the ulnar base of the proximal phalanx at the insertion of the ligament is the most common associated fracture pattern [27].
• A rare fracture pattern involves a rupture of the UCL from the proximal phalanx and a simultaneous articular shear fracture of the proximal phalangeal base [27].
• In the skeletally immature individual, isolated rupture of the UCL without a Salter fracture of the proximal phalanx is rare but does occur [27].

Clinical Examination

• Patients commonly report pain, swelling, and ecchymosis around the metacarpophalangeal joint [28].
• Tenderness is greatest over the ulnar aspect of the joint [28].
• Physical examination is performed with a valgus stress applied in neutral rotation to the thumb in both extension and 30° to 35° flexion [25].
• Stress testing in extension tests the accessory ligament, while stress testing in flexion tests the proper ligament [25].
• The ulnar side of the joint should be palpated for a Stener lesion [25].
• A Stener lesion is characterized by the proper and accessory ligament being retracted and lying on the adductor aponeurosis [25].
• Valgus instability of more than 30°—or more than 10° compared with the contralateral thumb in both flexion and extension—indicates complete rupture of the proper and accessory UCL [50].
• Instability of the MCP joint in flexion indicates rupture of the proper UCL only [50].
• A prominent lump can be palpated that represents the ulnar collateral ligament being proximally and superficially displaced by the adductor aponeurosis [28].
• Pathologic rotation of the thumb may be evident in complete UCL ruptures [28].
• Careful stress testing of the injured and uninjured side in both extension and flexion can often elucidate those with a significant tear of their UCL or RCL [22].
• The absence of a normal “endpoint” with radial stress is a key diagnostic finding signifying a complete ligament tear [22].
• For patients with significant guarding, a digital block may be necessary to carry out the stress test [22].
• Patients with a soft endpoint, incongruent joint, or Stener lesion require surgical intervention [22].

Imaging

• Plain radiographs should be obtained prior to any stress examinations to avoid displacing an otherwise nondisplaced fracture [25, 28].
• Stress radiographs are useful for identifying Stener lesions but are often uncomfortable for the patient and guarding may lead to false-negative results [25].
• Fluoroscopy can aid the diagnosis to see if the joint becomes incongruent and to measure the deviation compared to the contralateral limb [22].
• Ultrasonography (US) has evolved as a reliable adjunct to clinical examination in evaluation of the UCL of the thumb [6].
• MRI evaluation reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb MCP joint [17].
• A 4-stage, treatment-oriented classification of thumb UCL injury is based on the degree of UCL displacement, with correlation with the likelihood of success with either immobilization or operative intervention [19].
• The presence of a displaced fleck sign has implications for offering surgery to patients with thumb UCL injuries because of a high likelihood of a Stener lesion [18].
• A magnetic resonance imaging scan is recommended for additional preoperative planning because it provides a detailed assessment of tear location, injury grade, and ligament quality [50].
• In a study of 49 patients, US identified Stener lesions in 11 patients but only correctly identified 4, resulting in a sensitivity of 36% [30].
• In the same study, US demonstrated a low specificity (61%) and sensitivity (65%) for diagnosing displaced UCL ruptures [30].
• MRI and US of suspected UCL injury did not demonstrate good enough sensitivity to recommend their implementation and use in clinical situations in one study [30].
• Ultrasound or MRI can be helpful to gather more information when it is difficult to ascertain if there is a Stener lesion based on palpation [22].
• Imaging studies do not have 100% accuracy and their findings should only be one component of the decision-making algorithm [22].

Investigations

Clinical Examination

• The thumb MCP joint is generally examined by applying a radial force in extension and with approximately 30° of MCPJ flexion to relax the palmar plate, which is thought to isolate the UCL proper [7].
• Careful stress testing of the injured and uninjured side in both extension and flexion can often elucidate those with a significant tear of their UCL/RCL [22].

Imaging

• The clinical investigations for UCL injuries include plain radiographs or radiographs while applying a force to the MCPJ (stress radiographs), ultrasound (USS) and magnetic resonance imaging (MRI) scanning [7].
• In those patients where it is difficult to ascertain if there is a Stener lesion based on palpation, an ultrasound or MRI can be helpful to gather more information [22].
• Ultrasound and MRI studies do not have 100% accuracy and their findings should only be one component of the decision-making algorithm [22].
• Clinical assessment of a thumb ulnar collateral ligament injury should be supplemented with radiographs, as underlying pathology, such as an enchondroma, may be a factor [73].

Treatment

Non-Operative Management

• Incomplete acute tears and nondisplaced avulsion fractures are managed with a thumb spica cast for up to 4 weeks, followed by removable protective splinting for 3 more weeks with active range-of-motion exercises [25].
• Incomplete ruptures of the ulnar collateral ligament of the thumb are common and require only proper protection for restoration of function, although pain and swelling may persist for several months [28].
• A thumb spica cast or functional brace is recommended for 4 to 6 weeks for incomplete ruptures of the ulnar collateral ligament of the thumb [28].
• Tears of the UCL of the thumb MCP joint without a Stener lesion are believed to heal with 4 to 6 weeks of immobilization [36].
• A minimally displaced (<2 mm) avulsion fracture signifies a complete avulsion without a Stener lesion and usually heals with casting [28].
• Cast immobilization is generally believed to be adequate for small, minimally displaced or nondisplaced avulsion fractures, although one series found that nine of nine patients with small avulsion fractures and displacement of less than 2 mm had persistent pain after immobilization and all required secondary ORIF [27].

Indications for Surgery

• Acute complete rupture of the ulnar collateral ligament should be surgically repaired [28].
• The adductor aponeurosis interposition in a Stener lesion prevents direct ligament healing without surgery [25].
• Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations [2].

Operative Technique: Acute Repair

• Complete tears require open repair with suture anchors or bone tunnels placed at the site of the avulsion, which most commonly is the proximal phalanx [25].
• The surgical approach to the UCL involves a lazy S incision on the ulnar aspect of the thumb [16].
• The dorsal sensory branch of the radial nerve must be identified and retracted dorsally during the surgical approach [16, 22].
• The adductor aponeurosis is incised longitudinally to allow repair after the collateral ligament repair [16].
• The site of rupture is determined by identifying the torn ligament as distal off the phalanx, midsubstance, or proximal [16].
• Direct repair of the ligament should be obtained with the use of one or two bone anchors, preferably small metallic anchors with stout nonabsorbable suture material [22].
• A K-wire can be used to stabilize the joint prior to repair to allow for adequate tensioning of the repair [22].
• Additional sutures are used to augment the repair to the volar plate distally and capsule dorsally [22].
• The capsule and adductor aponeurosis should be repaired in separate layers [22].
• Repair techniques vary substantially, with options including a pullout suture and button, bone anchors, or a combination of the two with local tissue augmentation or imbrication [37].
• Both pull-out suture and bone anchor repair methods are safe and effective for treating thumb ulnar collateral ligament injuries [23].
• In this model, thumb UCL repair with suture tape augmentation demonstrated greater maximum and clinical failure loads compared with nonaugmented repair at time 0, that is, without any biological healing [70].

Operative Technique: Chronic Repair and Reconstruction

• If the diagnosis of acute complete rupture is delayed for 1 month or longer, fibrosis makes ligament identification and repair more difficult, although repair can be done by dissecting out the ligament from within the fibrotic mass and reattaching it appropriately [28].
• The detached tendinous insertion of the adductor muscle can be advanced and reattached to furnish a dynamic reinforcement in chronic repairs [28].
• For chronic tears with excessive laxity, the adductor insertion can be advanced to increase dynamic stability [22].
• If the repair is done several months after the injury, a graft can be used [28].
• Graft reconstruction of the UCL can often be accomplished with either an autograft palmaris/plantaris tendon or with an allograft [22].
• Newer techniques for chronic reconstruction involve the use of 3.0-mm drills, the graft, fibertape, and interference screws [22].
• An X or Y type configuration is often needed to appropriately reconstruct the surface area of the ligament to prevent recurrent instability in chronic cases [22].
• If a Y construct is used for chronic reconstruction, it is preferred to place the single limb distally and the dual limb proximally to prevent iatrogenic injury [22].
• A K-wire is highly recommended in chronic UCL repairs to allow adequate healing and to provide sufficient stability to permit early mobilization of the adjacent IP and CMC joints [22].
• The pin is typically removed in the office at 6 weeks after chronic UCL repair [22].
• No static ligament reconstruction restores the normal stability characteristics of the thumb UCL [5].

Postoperative Management and Outcomes

• Strenuous activity is avoided for 3 months, with unrestricted return to sport usually at 2 to 3 months [25].
• Surgical management of thumb UCL injuries produces overall favorable results [1].
• Complications are rare and most patients show preservation of motion, key pinch, and grip strength [12].
• The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases [21].
• Thumb ulnar collateral ligament injuries can be safely and effectively managed by football position demands [14].
• Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft [24].
• Surgery provides good results with a low rate of long-term complications [26].

Complications

• Eighty-eight percent of patients had some degree of osteoarthritis following primary repair of chronic thumb UCL injuries [38].
• Increased age at the time of injury and higher DASH scores were correlated with increased grades of the thumb metacarpophalangeal osteoarthritis in patients with chronic UCL injuries [38].
• Delay to treatment and VAS pain scores had no correlation with radiographic findings in patients with chronic UCL injuries [38].
• The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate [61].
• Long-term dangers and the cost effectiveness of the procedure using the Fiji Anchor® for thumb UCL lesions are not known yet [61].

Recovery

General Outcomes

Athlete Return to Play

• Players who underwent thumb UCL repair played in a similar number of games per season and had similar career lengths in the MLB as controls [10].
• Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes [63].
• Players who underwent thumb UCL surgery played in a similar number of games per season and had similar career lengths in the NFL as controls [78].

Long-Term Complications

• Repair of a chronic UCL injury with available local tissue appears to be a reasonable alternative to ligament reconstruction, resulting in durable long-term outcomes despite the majority of patients progressing to osteoarthritis [38].

Key Evidence

• [L1] Surgical management of thumb UCL injuries produces overall favorable results. [1] (10.5435/jaaosglobal-d-25-00082)
• [L5] Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint can lead to long-term pain and functional limitations. [2] (10.2106/jbjs.k.01024)
• [L3] The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. [3] (10.1177/1558944716681974)
• [L4] Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications. [4] (10.1016/j.jhsg.2023.03.005)
• [L5] No static ligament reconstruction restores the normal stability characteristics of the thumb UCL. [5] (10.1016/j.jhsa.2004.09.012)
• [L4] Ultrasonography (US) has evolved as a reliable adjunct to clinical examination in evaluation of the UCL of the thumb. [6] (10.1148/rg.264055117)
• [L1] [7] (10.1177/17531934241274612)
• [L5] Sequential tearing of the thumb UCL leads to progressive instability of the MCP joint. [8] (10.1177/1558944719868518)
• [L5] 75% of cases with complete rupture of the ulnar collateral ligament of the thumb will fail to heal with conservative treatment. [9] (10.1007/s11552-008-9145-8)
• [L3] Players who underwent thumb UCL repair played in a similar number of games per season and had similar career lengths in the MLB as controls. [10] (10.1177/2325967117747268)
• [L2] Patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. [11] (10.1016/j.jhsa.2023.05.003)
• [L5] Complications are rare and most patients show preservation of motion, key pinch, and grip strength. [12] (10.1016/j.ocl.2014.11.007)
• [L3] Patients with both acute and chronic thumb UCL injuries have similarly acceptable functional outcomes, postoperative pain, and satisfaction. [13] (10.1016/j.jhsg.2022.02.008)
• [L4] Thumb ulnar collateral ligament injuries can be safely and effectively managed by football position demands. [14] (10.1177/2325967114s00092)
• [L4] It could be an alternative treatment technique for thumb UCL avulsion fractures. [15] (10.1016/j.otsr.2019.01.008)
• [L4] MRI evaluation reveals greater details enabling better understanding and management of ulnar collateral ligament injuries of the thumb MCP joint. [17] (10.1016/s0363-5023(09)60139-8)
• [L4] Presence of a displaced fleck sign has implications for offering surgery to patients with thumb UCL injuries because of a high likelihood of a Stener lesion. [18] (10.1016/j.jhsa.2024.12.003)
• [L4] Our 4-stage, treatment-oriented classification of thumb UCL injury is based on the degree of UCL displacement, with correlation with the likelihood of success with either immobilization or operative intervention. [19] (10.1016/j.jhsa.2014.08.033)
• [L4] Treatment of a thumb UCL complete rupture (Grade III) using a custom-made hinged splint shows promise in the conservative management of compliant patients. [20] (10.1016/j.jht.2009.10.001)
• [L5] The functional results of operative treatment are excellent, resulting in a stable and painless thumb in the vast majority of cases. [21] (10.5435/00124635-199707000-00006)
• [L3] Both repair methods are safe and effective for treating thumb ulnar collateral ligament injuries. [23] (10.1097/prs.0b013e3181882163)
• [L4] Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. [24] (10.1016/j.jhsa.2024.05.005)
• [L4] [26] (10.1016/j.injury.2009.01.107)
• [L4] [30] (10.1177/1753193420932496)
• [L4] Comparison with the uninjured contralateral thumb is unreliable in many individuals due to significant variation between right and left thumbs. [32] (10.1177/1753193408100957)
• [L4] [38] (10.1177/1558944716628482)
• [L5] [50] (10.1016/j.eats.2025.103957)
• [Paper] The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet. [61] (10.1007/s00402-020-03625-x)
• [L4] Collegiate football athletes treated for thumb UCL injuries with suture anchor repair had quick return to play, reliable return to the same level of activity, and excellent long-term clinical outcomes. [63] (10.1016/j.jhsa.2014.06.132)
• [L5] In this model, thumb UCL repair with suture tape augmentation demonstrated greater maximum and clinical failure loads compared with nonaugmented repair at time 0, that is, without any biological healing. [70] (10.1016/j.jhsa.2018.02.002)
• [L5] This case highlights that clinical assessment of a thumb ulnar collateral ligament injury should be supplemented with radiographs, as underlying pathology, such as an enchondroma, may be a factor. [73] (10.1177/17531934251315313)
• [L4] Players who underwent thumb UCL surgery played in a similar number of games per season and had similar career lengths in the NFL as controls. [78] (10.1177/1558944718760001)

References

[1] Surgical Management of Thumb Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis of 614 Patients With a Minimum 1 Year Follow-up. JAAOS: Global Research and Reviews. 2025. DOI: 10.5435/jaaosglobal-d-25-00082

[2] Management of Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries. Journal of Bone and Joint Surgery. 2012. DOI: 10.2106/jbjs.k.01024

[3] Variation in the Rate of Surgery for Ulnar Collateral Ligament Injury of the Metacarpophalangeal Joint of the Thumb. HAND. 2016. DOI: 10.1177/1558944716681974

[4] Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.005

[5] Reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint: A cadaver study. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.09.012

[6] US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis. RadioGraphics. 2006. DOI: 10.1148/rg.264055117

[7] Guideline on managing thumb ulnar collateral ligament injuries: the British Society of Surgery for the Hand Evidence for Surgical Treatment (BEST) findings and recommendations. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241274612

[8] Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics. HAND. 2019. DOI: 10.1177/1558944719868518

[9] Injury to the Ulnar Collateral Ligament of the Thumb. HAND. 2008. DOI: 10.1007/s11552-008-9145-8

[10] Performance and Return to Sport After Thumb Ulnar Collateral Ligament Repair in Major League Baseball Players. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117747268

[11] Patient-Reported Outcomes and Function After Surgical Repair of the Ulnar Collateral Ligament of the Thumb. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.05.003

[12] Ulnar Collateral Ligament Injuries of the Thumb. Orthopedic Clinics of North America. 2015. DOI: 10.1016/j.ocl.2014.11.007

[13] A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.02.008

[14] Return to Play and Long-Term Clinical Outcomes after Suture Anchor Repair of Thumb Ulnar Collateral Ligament Injuries in Collegiate Football Athletes. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00092

[15] Mini hook plate fixation for thumb ulnar collateral ligament avulsion fracture: A technical report. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.01.008

[16] Rockwood And Green S Fractures In Adults. 42: Fractures of the Distal Radius and Ulna > Open Repair of the Ulnar or Radial Collateral Ligament of the MCP Joint of the Thumb: Preoperative Planning Checklist.

[17] MRI Classification of Ulnar Collateral Ligament Injuries of the Thumb MCP Joint. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60139-8

[18] The Displaced Fleck Sign: Description of a Radiographic Finding Consistent with Grade III Thumb Ulnar Collateral Ligament Tears with Stener Lesions. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.003

[19] Gamekeeper’s Thumb—A Treatment-Oriented Magnetic Resonance Imaging Classification. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.08.033

[20] Treatment of Grade III Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries with Early Controlled Motion Using a Hinged Splint. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2009.10.001

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