My teenage son injured his thumb while playing rugby over the Christmas holidays. As it didn't look too bad at the time I just strapped it, presuming it was just a sprain.
However, by the following day it had become very painful and he could not use the thumb to pick up things. At our local accident and emergency department he had an X-ray and, as no fracture showed up, he was diagnosed with gamekeeper's injury. What exactly is this and why is it so named?
Hand injuries commonly cause pain, swelling, stiffness and limitation of movement. The most common injuries are ruptures (tears) of the ligaments and fractures of the small bones. Gamekeeper's thumb occurs when the ligament of the palm side of the thumb is ruptured.
This ligament produces the pinching movement of the thumb, which explains why your son was having difficulty picking up objects. This type of injury can occur as the result of a fall which jams the thumb backwards onto a hard surface.
However, it is said to have originally got its name from an occupational injury common among gamekeepers who often developed the condition from wringing the necks of rabbits at the end of a shoot.
My son was fitted with a splint and he was given some painkillers while in casualty. However, two weeks later he's itching to take the splint off. As the hospital staff didn't mention how long he had to wear it, I'm reluctant to let him remove it yet.
A small splint is routinely used to immobilise the joint, allowing the injured soft tissues (ligaments and muscles) to heal. Without the splint, the tear may not heal properly and permanent deformity of the joint can occur.
Your son should be advised not to remove the splint until the injury has been reviewed by his doctor.
If he has not been given an appointment at the hospital for follow-up, you should contact them to arrange for him to be seen again at a hand injury clinic or in the outpatient department.
He may also require a referral for physiotherapy as early mobilisation of the hand should help prevent loss of function.
If the ligament does not heal correctly, it can lead to the bones moving out of place, necessitating surgical repair.