Skier’s Thumb and Gamekeeper’s Thumb: Sprained Thumb or Torn Ligament?

Written by Mavis Tham, Shamaine Soh and Yuna Zhuang, Principal Hand Occupational Therapists at Phoenix Rehab.Clinically reviewed by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z.Last reviewed 7 October 2026.

Skier’s thumb and gamekeeper’s thumb are two names for one injury: a sprain or tear of the ulnar collateral ligament (UCL), on the index-finger side of the thumb knuckle. Skier’s thumb is the sudden version, from a fall or ball forcing the thumb outward. Gamekeeper’s thumb began as the name for the slow version: the ligament stretched by repeated strain.

A sprained thumb usually means the ligament on the inside of the thumb knuckle has been stretched or torn. The question that decides everything is whether it is partly or completely torn, because a complete tear often cannot heal on its own however long you splint it.

The ligament is the ulnar collateral ligament, or UCL. Skiers tear it on a pole, which is why it is called skier’s thumb, and the older name is gamekeeper’s thumb. In Singapore it is a fall with the hand out, a ball on the thumb, a motorcycle handlebar, or a thumb caught in a bag strap.

Skier’s thumb and gamekeeper’s thumb: how the ligament tears

The UCL is a short, strong band on the index-finger side of the thumb knuckle, the joint where the thumb meets the hand. It stops the thumb bending outward, away from the fingers, when you pinch. Force the thumb past that point and the ligament stretches or tears.²

Skier’s thumb: the sudden version

The textbook picture is a fall on an outstretched hand with a ski pole in it. The pole handle levers the thumb outward and back as you land, which is why our ski injuries page puts the thumb near the top. In Singapore it is more often a ball: the thumb bent back on a volleyball block, a hard pass in basketball or netball, or a shot that catches a goalkeeper’s thumb. A fall off a bicycle or motorcycle with the hand still on the handlebar does the same.

Gamekeeper’s thumb: the slow version

A surgeon named Campbell described it in 1955, in Scottish gamekeepers whose thumbs had loosened over years of dispatching wounded rabbits by hand.¹ Their ligaments never tore in one go. They stretched, a little at a time, until the knuckle gave way on a pinch. Today the two names are used for the same injury. The slow version now turns up after an old sprain that healed loose: the thumb aches on the jar lid and folds when you grip the handle of a heavy pot.

Jammed thumb or sprained thumb?

A jammed thumb and a sprained thumb are usually the same injury described two ways. The thumb was forced back or out to the side, and the ligament at the knuckle took the load. The word matters less than one question: does the thumb still hold when you pinch? Mild ones settle in two to four weeks. A thumb that feels loose needs a doctor first.

How to tell it is that ligament

The pattern is specific and you can check it yourself.

• Pain and swelling on the inside of the thumb, at the web between thumb and index finger, not at the tip and not on the back of the wrist.
• Bruising appearing in that web space a day or two later rather than immediately.
• Pain and weakness specifically when you pinch or turn a key. That is exactly the movement the ligament resists, which is why it is the giveaway.
• A thumb that feels loose, or gives way, when you pinch hard.

Which thumb ligament is it?

Three ligaments hold the thumb knuckle, and each one hurts in its own place. Put a finger on the sore spot.

All three can pull a flake of bone off with them, and two can happen together, so a doctor confirms which one it is. The same backward injury in a finger is covered on our volar plate injury page.

Broken or sprained?

You cannot tell from how much it hurts. A bad sprain hurts more than some fractures, and the one injury you most want to identify, a complete tear, can hurt less than a partial one because the torn ends are no longer being stressed.

Points towards a fracture: tenderness directly over bone rather than the soft tissue beside the joint; pain on gentle pressure along the length of the thumb; visible deformity or a thumb sitting at an angle; immediate dramatic swelling and bruising.

Points towards a ligament: the four signs above, particularly weakness on pinch.

Both lists overlap, and a fracture and a ligament injury often happen together, which is why a thumb injured in a fall gets an x-ray rather than a guess.

Partial tear or complete tear?

Doctors grade a UCL injury by how much of the ligament tore. A stretched ligament (grade 1) and a partial tear (grade 2) leave the knuckle stable when it is tested. A complete tear (grade 3) lets the knuckle open on the index-finger side.²

Partial tears are treated in a splint. Complete tears are commonly repaired by a hand surgeon,² and a Stener lesion, explained below, is the reason why. Your doctor tests the stability against your other thumb and decides whether you need an X-ray, ultrasound or MRI. That decision is theirs, not ours.

The one that needs a doctor first, and why

This is the section worth reading even if you never come in. When the inside ligament tears completely, a sheet of tendon can slide underneath the torn end and sit between it and the bone it needs to heal to. That is called a Stener lesion. The ligament then has nothing to reach, and no amount of splinting or therapy will change that. It needs surgical repair, and the results are better when it is done in the first few weeks.

The Swedish surgeon Bertil Stener described this in 1962, and it is still the reason a loose thumb after a fall goes to a hand surgeon before it goes into a splint. A complete tear found months later can still be treated, but usually by reconstructing the ligament with a tendon graft rather than repairing it.

Sources: Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Br 1962;44:869-879. Poggi DS et al. The treatment of chronic ulnar collateral ligament injuries of the thumb, 2020.

An x-ray also matters because a fragment of bone often comes away with the ligament, and where that fragment sits changes the plan.

So the order is doctor, imaging, then therapy. If you have thumb pain with weakness on pinch after a fall, get it looked at rather than strapping it and waiting. Your GP can arrange the x-ray and the referral; which clinic you end up at matters far less than that someone has ruled this out.

Can you feel a Stener lesion?

Sometimes. The torn end of the ligament, folded back on top of the tendon sheet, can form a small, firm lump on the index-finger side of the thumb knuckle.² Not every Stener lesion can be felt, so finding no lump does not rule one out. A lump there after the injury, or a thumb that gives way when you pinch, goes to a doctor soon for an X-ray and a hand surgeon’s review.

The other injury hiding here

If the sore spot is not the thumb itself but the hollow at the base of your thumb on the back of the wrist, that points at the scaphoid instead. A scaphoid fracture commonly does not show on the first x-ray and is the classic missed injury of the wrist. Say specifically where it hurts and ask about it. Our scaphoid fracture program explains why that one is worth being annoying about.

What to do in the first 48 hours

Whichever it turns out to be, the first two days are the same.

• Protect it from the movement that hurts. Pinching and side to side stress, not gripping.
• Elevate the hand above the level of your heart, which is higher than most people hold it.
• Move the fingers and the wrist fully, often. Hands stiffen fast.
• Do not strap it tightly across the web space, and do not keep testing how loose it feels to see whether it is still loose.
• Leave taping for later. Taping is for going back to sport once the ligament has been checked, not a substitute for finding out whether it is torn.
• Get it seen.

When to see a doctor first

• Call 995 for bleeding that does not slow with firm pressure, or if part of the thumb has been cut off.
• Go to the emergency department now if the thumb sits at an angle or the knuckle looks out of place after a fall, if there is a deep or dirty wound over the knuckle, or if the thumb turns white or cold.
• See a doctor the same day if the thumb is numb after the injury, if you have a small wound over the knuckle, or if swelling and bruising came up within hours and you cannot pinch at all.
• See a doctor the same day, before any splinting, if the thumb gives way or feels loose when you pinch, or you can feel a lump at the base of the thumb on the index-finger side. Ask for an X-ray and a hand surgeon’s review. Repair of a complete tear has better results in the first few weeks.

What a hand therapist tests

• Pinch strength, in kilograms. Key pinch, the grip you use on a key, and tip pinch, with a pinch gauge on both hands.
• Knuckle movement, in degrees. How far the thumb knuckle bends and straightens, against the other thumb.
• Where it is tender. The index-finger side, the outer side, the palm side, or the hollow at the base of the thumb.
• Stability, with care. We compare the knuckle with your other thumb without forcing it open. If it feels loose and no doctor has checked it, we stop there and send you back to your doctor.
• What you need the thumb for. A hand function questionnaire, and the tasks you name: the key, the jar, the racquet, the handlebar.

X-rays, ultrasound and MRI are your doctor’s call. Therapists do not order imaging.

The splint: a hand-based thumb splint, made in the appointment

A partial tear, and a repair once the cast comes off, are protected in a thumb spica splint. The one we make most often is hand-based: it wraps the thumb knuckle and the base of the thumb, and leaves the thumb tip and the wrist free, so you can still hold a pen and type. Your therapist molds it from thermoplastic on your hand during the appointment, then reshapes it as the swelling goes down. Where a bone fragment or your doctor’s plan needs the wrist held too, the splint extends onto the forearm. More on how we make them: custom made hand splints.

In Stage 1 you wear it full time, off only for skin care with the thumb held still. Strapping across the web space is not a substitute. Tape comes later, for the return to sport.

How long does a jammed or sprained thumb take to heal?

It depends on how much of the ligament tore. A mild sprain usually settles in two to four weeks. A partial tear is splinted for about four to six weeks and takes around three months before heavy pinch and ball sport. A complete tear repaired by a surgeon follows a similar three-month shape, counted from the day of the operation.

Typical ranges, not predictions for your thumb. Your doctor’s or surgeon’s plan takes precedence.

After a UCL repair: where therapy starts

If a hand surgeon has repaired the ligament, you usually wake up in a cast or a splint, and therapy starts when your surgeon allows. From there the Thumb Ligament Recovery Program runs on your surgeon’s timing: a custom splint replaces the cast, the knuckle starts to bend and straighten, then pinch is loaded and measured. The week-by-week below shows the usual shape. Bring the operation note to your first appointment. If your surgeon referred you, they receive a one-page report at weeks 2, 6 and 12. For other operations on the hand and wrist, see hand therapy after surgery.

Hand therapy, with or without surgery

Thumb Ligament Recovery Program

A torn thumb ligament can hurt less than a partial one. Pinch tells you more than pain does.

For skier’s thumb, a jammed or sprained thumb that has not settled, partial ulnar collateral ligament tears treated in a splint, and recovery after surgical repair. A staged hand therapy program at five Singapore clinics.

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No referral needed to start. Bring your x-ray report, scan report or operation note.

Start here

Where are you right now?

A thumb ligament injury is a different problem depending on where you are with it. Pick the one that matches.

It happened in the last few daysWhat to do first, and when it needs a doctor.I am in a splint, or just had it repairedWhat is usually normal, and what is not.It has been weeks and pinch is still weakWhy it stalls, and what changes it.When can I play, drive or lift again?Typical points, and what has to be true first.

How the program runs

4-Stage Structured Recovery

You move up a stage when you meet the criteria for it, not when a number of weeks has passed. That is Criteria Before Clearance, and it is why the last appointment is a graduation rather than a discharge.

Stage 1

Calm & Protect

A custom hand-based thumb splint holds the knuckle still and leaves the tip and the wrist free. Swelling down, fingers and wrist moving.

Most people arrive here

Stage 2

Move & Mobilize

The splint comes off for gentle bending and straightening of the knuckle, with no sideways stress. Splint on for activity and at night.

Stage 3

Rebuild & Strengthen

Key pinch and tip pinch loaded in steps and measured in kilograms against the other hand. The splint is weaned.

Stage 4

Return & Perform

Keys, jars, ball handling, and the grip on a racquet, pole or handlebar. Taping or a protective splint for the first weeks back at sport.

• Stage 1, move up when: your doctor has confirmed the tear is partial, or your surgeon allows movement after a repair; pain at rest has settled; and the splint fits without pressure marks.
• Stage 2, move up when: bending and straightening at the knuckle measure close to the other thumb, and there is no new looseness when the joint is checked.
• Stage 3, move up when: pinch is rising at each review, pinching does not bring the pain back at the knuckle, and the thumb holds steady under load.
• Stage 4, graduate when: pinch meets what your work and sport need, tested with the tasks themselves, and the thumb is stable at two reviews in a row.

Measured at your first appointment and again at graduation: a hand function questionnaire, key pinch and tip pinch strength in kilograms, and how far the thumb knuckle bends and straightens in degrees, on both hands.

The shape of it

What happens, week by week

Two common shapes. The weeks are typical ranges, not a promise, and a mild sprain moves faster. Your doctor’s or surgeon’s protocol takes precedence over anything on this page, every time.

A partial tear, treated in a splint (weeks from the injury)

• Weeks 0 to 3Stage 1 · Calm & ProtectCustom splint worn full time, off only for skin care with the thumb held still. Fingers, wrist and the thumb tip kept moving.
• Weeks 3 to 6Stage 2 · Move & MobilizeSplint off a few times a day for gentle bending and straightening at the knuckle. Splint on for activity and at night.
• Weeks 6 to 10Stage 3 · Rebuild & StrengthenPinch loaded and measured. The splint is weaned as pinch holds.
• Weeks 10 to 12 and onStage 4 · Return & PerformHeavy pinch and sport, with taping or a protective splint for ball and contact sport up to about three months.

After surgical repair (weeks from the operation)

• Weeks 0 to 4Stage 1 · Calm & ProtectCast or splint as your surgeon set it. Wound care, swelling, fingers moving.
• Weeks 4 to 8Stage 2 · Move & MobilizeA custom splint replaces the cast. Knuckle bending and straightening start on your surgeon’s timing.
• Weeks 8 to 12Stage 3 · Rebuild & StrengthenPinch loaded once your surgeon allows it.
• Week 12 onwardStage 4 · Return & PerformSport and work loads, protected for contact sport for the first weeks back.

In the splint, or after a repair

Is this normal?

Usually expected

• Bruising in the web space that spreads and turns yellow over two to three weeks.
• Skin that is pale and wrinkled under the splint when it is changed.
• A knuckle that is stiff when the splint first comes off.
• An ache with heavy pinch for a few months.
• A knuckle that looks slightly thicker than the other side, sometimes for good.

Contact your doctor

• Emergency department now: a thumb sitting at an angle, or a joint that looks out of place, after a fall.
• Doctor the same day: after surgery, fever, or a wound that is red, hot, opening or leaking. A thumb that turns white, cold or numb in the splint: loosen it, and if that does not settle it, be seen today.
• Doctor the same day, before more splinting: a thumb that feels loose or gives way when you pinch. A complete tear is best repaired in the first few weeks.
• Surgeon soon: a pop followed by new looseness after a repair.
• Review soon: knuckle pain that is not reducing over two to three weeks in the splint, or numbness along the thumb that is not improving.

A thumb base that grinds on rotation and aches with jar lids is a different problem, arthritis rather than ligament, and that has its own thumb joint page.

We would rather send you back to your doctor early than be the reason you went late.

If it is not going to plan

Six weeks on and you still cannot open a bottle

The splint is off. The bruising has gone. You still pass the jar to someone else, and turning a key takes two tries.

It has stopped hurting much, so it feels finished. Pinch strength says otherwise. Measured in kilograms against the other thumb, most people at this point are well down, and nobody has told them, because nobody has measured it.

That gap responds to loading, not to waiting. If the thumb also feels loose when you pinch, the question goes back to a doctor first: a ligament that did not heal to the bone will not be trained into holding.

The Stalled Recovery Review is three appointments, one a week for three weeks, with the same therapist. The first finds what is holding you back. The next two measure how it responds, because what a joint does under load cannot be read in one visit. $690, nett, no GST.

Tell us where it stopped

More on what the three appointments cover: the Stalled Recovery Review.

Logistics

When can I…

Your doctor or surgeon decides, based on healing and what your job demands. These are typical points, not permissions.

Activity	Typical point	What has to be true first
Typing, writing, desk work	From the first days	Splint on. The thumb tip stays free for a pen.
Showering	From day one	The splint protected, or removed with the thumb held still, as your therapist shows you at the first visit.
Driving	2 to 6 weeks	A grip on the wheel you trust, and your doctor agrees. After surgery, your surgeon decides. Check your insurer.
Gym, push-ups, weights in the hand	8 to 12 weeks	Pinch tested against the other hand, and no looseness at the knuckle.
Ball sport, climbing, grappling, skiing	About 3 months	Stage 4 criteria met, with taping or a protective splint for the first weeks back.
Medical certificate	Your doctor issues it	Hand therapists do not issue MCs. We can write a report on your functional limits for your doctor or employer.

The program

What it costs and what is in it

Thumb Ligament Recovery Program, Stages 1 to 4

$230

Per 45-minute appointment, nett, no GST. The Thumb Ligament Recovery Program is 12 appointments, $2,760 in all. You pay for each appointment as you attend it. If you need more, your therapist shows you which stage criteria are still open, and each extra appointment is $230. A custom hand-based thumb splint, where one is needed, is $200 on top of the appointment, or $300 if it has to include the wrist.

• An Assessment & Treatment first, at $230: which stage you are in, what is limiting you, and a written plan you walk out holding
• A custom thumb splint molded during the appointment, where one is needed
• Pinch in kilograms and knuckle range in degrees, measured against the other hand
• A home program, written down
• A one-page report to your surgeon at weeks 2, 6 and 12 if you were referred after a repair
• Your next stage review dated into the diary, with the same therapist

Graduation, Not Discharge. The program ends when you meet the Stage 4 criteria for your work and the tasks you named at the start.

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Who you will see

The hand therapy team that runs this program

Hand, wrist and elbow cases are managed by the hand therapy team. You are matched to the therapist whose declared clinical interest fits what happened to you and the clinic that suits you, and you stay with the same therapist through the program. Every appointment is one to one with your therapist for the full 45 minutes. All are registered with the Allied Health Professions Council.

Mavis Tham

Principal Hand Occupational Therapist. Wrist fractures, TFCC and wrist ligament injuries, custom splinting.

Tanjong Pagar

Shamaine Soh

Principal Hand Occupational Therapist. Stiffness and scar tightness after hand or wrist surgery.

Orchard, Sundays

Yuna Zhuang

Principal Hand Occupational Therapist. Carpal and cubital tunnel, sports wrist and finger injuries, tennis elbow.

Orchard, Serangoon, Tampines

Nurul Nadzirah

Principal Hand Occupational Therapist. Finger and wrist fractures, De Quervain’s, wrist ligament injuries.

Orchard

Jasmine Ang

Principal Hand Occupational Therapist. TFCC and wrist ligament injuries, trigger finger, thumb and wrist pain after pregnancy.

Jurong East, from 25 October

The program belongs to Phoenix, not to one therapist. Your plan, your measurements and your surgeon’s protocol move with you if you change clinic.

This program runs Stages 1 to 4 of the Phoenix Recovery Protocol. It sits under hand therapy after surgery, alongside the other recovery programs.

Timings on this page are typical ranges, not predictions for any individual recovery, and your doctor’s or surgeon’s protocol takes precedence. Hand therapists assess, splint, exercise, educate and refer; doctors diagnose, inject, prescribe and order imaging. If we find something that needs medical review we refer you back to your doctor.

Sources for the sections on skier’s and gamekeeper’s thumb: 1. Campbell CS. Gamekeeper’s thumb. J Bone Joint Surg Br. 1955;37-B:148-149. 2. Avery DM, Inkellis ER, Carlson MG. Thumb collateral ligament injuries in the athlete. Curr Rev Musculoskelet Med. 2017;10(1):28-37.

  
 
 
 
  
 
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Amazing experience with Phoenix Rehab, was assisted by Mavis. She’s very kind and professional and did thorough check on my wrist. I feel very comfortable during the process.

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