Expert Surgical Intervention for Thumb Ligament Injuries
A torn or ruptured ligament in the thumb can cause significant weakness, pain, and instability in the hand. When the ulnar collateral ligament (UCL) is injured, the thumb joint often feels loose and unstable, especially when gripping objects or applying pressure to the palm. Dr. Thomas Neustein, a board-certified orthopedic hand and upper extremity surgeon, offers advanced thumb ligament surgery using the internal brace technique to restore strength, motion, and long-term joint stability.
At Specialty Orthopaedics, patients from Duluth, Dawsonville, and Braselton receive expert care for thumb UCL reconstruction, chronic injury management, and other complex hand and wrist conditions.
Understanding the Ulnar Collateral Ligament
The ulnar collateral ligament is a key stabilizer of the thumb metacarpophalangeal (MCP) joint. It connects the metacarpal bone to the proximal phalanx and prevents excessive sideways movement of the thumb. When the ligament is overstretched, torn, or completely ruptured, the thumb loses stability and may no longer function properly.
This type of injury is a common injury in both athletes and everyday individuals who sustain trauma to the thumb or fall onto an outstretched hand. Without treatment, the ligament cannot heal correctly, leading to long-term weakness and arthritis.
What Is a Thumb UCL Injury
A thumb UCL injury occurs when excessive force bends the thumb away from the index finger. This force may stretch or completely tear the ligament, resulting in a partial tear or complete tear. Such ligament injuries are often seen in high-impact sports, especially those that involve gripping or contact with the palm.
This injury is also known as skier’s thumb when caused by a fall with a ski pole, and gamekeeper’s thumb when the injury becomes chronic due to repetitive stress. In both cases, the UCL fails to keep the thumb stable, leading to pain and loss of function.
How Thumb Ligament Injuries Occur
A thumb UCL tear can happen in many ways:
- Falling on an outstretched hand
- Forceful bending of the thumb joint away from the palm
- Catching a ski pole, ball, or racquet during sports
- Chronic stress from repetitive gripping or twisting tasks
- Work-related trauma that causes strain or sprain of the ligament
Sometimes a small fragment of bone detaches with the ligament, creating an avulsion fracture that must be treated surgically.
Symptoms of a Torn Thumb Ligament
Typical signs of a torn UCL include:
- Pain along the inner side of the MCP joint
- Tender swelling and bruising at the base of the thumb
- Weakness when gripping, pinching, or lifting objects
- Sensation of looseness or thumb instability
- Stiffness and reduced range of motion
- Difficulty applying pressure to the palm
These symptoms indicate that the thumb ligament may not be functioning normally and should be evaluated by a hand specialist.
Diagnostic Procedures and Examination
Accurate diagnosis is essential to ensure the ligament is treated properly. Dr. Neustein performs a thorough examination of the hand and wrist, testing the stability of the thumb MCP joint and identifying areas of tenderness or swelling.
Diagnostic procedures may include:
- X-rays to look for avulsion fracture or bone displacement
- MRI to evaluate soft-tissue damage and complete tear
- Ultrasound to assess ligament motion and healing potential
These studies help determine whether conservative care or surgical intervention will best facilitate healing.
Classification of Thumb Ligament Injuries
Thumb UCL injuries are classified based on severity:
- Grade I: Mild sprain or stretch without rupture
- Grade II: Partial tear causing moderate instability
- Grade III: Complete rupture or torn UCL detached from bone
A Stener lesion occurs when the ligament is trapped above nearby tissue, making natural healing impossible. This situation requires thumb ligament surgery to restore normal stability.
Non-Surgical and Home Treatment Options
For mild or moderate sprains, non-surgical treatment can help alleviate swelling and promote recovery. Early immobilization in a thumb spica splint allows the ligament to rest and heal.
Additional conservative measures include:
- Rest, ice, compression, and elevation to reduce swelling
- Anti-inflammatory medication to decrease pain
- Home treatment with gentle motion exercises once cleared
- Hand therapy to restore range of motion and grip strength
If the ligament does not heal or the thumb joint remains unstable, surgical intervention is recommended to repair or reconstruct the damaged tissue.
When Surgery Is Recommended
Surgery is indicated for severe sprains, chronic injury, complete rupture, or failure of conservative management. It is also required when imaging shows an avulsion fracture or Stener lesion.
Without repair, the thumb joint may remain unstable, causing chronic pain and loss of function in the long term. Early evaluation ensures the ligament heals in proper alignment and the thumb remains strong and stable.
Thumb UCL Reconstruction with Internal Brace
Thumb UCL reconstruction with internal brace technology is a highly reliable surgical treatment for complete tears and chronic ligament injuries. The internal brace reinforces the ligament repair with a collagen-coated suture tape, giving the joint immediate strength while the native tissue heals.
During thumb ligament surgery, Dr. Neustein reattaches or reconstructs the ligament using small anchors and the internal brace system. This advanced approach allows early motion and faster recovery without compromising stability.
What to Expect During Surgical Intervention
- A small incision is made over the ulnar side of the thumb.
- The torn UCL and MCP joint are carefully exposed.
- If tissue quality is good, the ligament is repaired directly to bone.
- If damaged or retracted, a tendon graft is used to reconstruct the ligament.
- A suture-tape internal brace is added to protect the repair.
- The thumb joint is tested for stability and aligned properly.
- The wound is closed, and a thumb spica splint is applied.
This outpatient procedure typically takes under an hour and is performed under regional anesthesia for maximum comfort.
Benefits of the Internal Brace Technique
- Immediate joint stability after repair
- Earlier rehabilitation with reduced stiffness
- Faster return to high-impact sports and daily activities
- Stronger, more durable ligament reconstruction
- Reduced risk of re-injury or chronic instability
The internal brace acts like a safety belt for the thumb, providing support while the ligament heals naturally.
Recovery and Rehabilitation After Surgery
Phase 1 (0–2 weeks): The thumb remains immobilized in a protective splint. Rest and elevation are emphasized to alleviate swelling.
Phase 2 (2–6 weeks): Gradual range-of-motion exercises begin under supervision.
Phase 3 (6–12 weeks): Strengthening of grip, pinch, and coordination between the thumb and index finger.
Phase 4 (3–6 months): Full recovery and return to sports, manual work, or hobbies.
Physical therapy plays a major role in restoring balance between the thumb and palm, ensuring the thumb remains stable and functional.
Long-Term Outcomes
When treated properly, patients achieve excellent long-term results with full motion and strength. Most individuals return to their usual activities within three to six months. Chronic pain and instability are rare when surgery and rehabilitation are completed as directed.
Risks and Considerations
Potential risks include infection, nerve irritation, or stiffness. These are uncommon and minimized by proper surgical technique and postoperative care. With the internal brace method, the likelihood of recurrence or incomplete healing is significantly reduced.
Why Choose Dr. Thomas Neustein
Dr. Thomas Neustein is a fellowship-trained orthopedic hand and upper extremity surgeon specializing in thumb and wrist ligament repair. His expertise in thumb UCL reconstruction and internal brace technology has helped patients throughout North Georgia regain confidence, function, and quality of life after severe sprains, torn UCL injuries, and chronic instability.
His comprehensive approach ensures each patient receives personalized care—from diagnostic evaluation through surgical intervention and guided rehabilitation.
Other Conditions Treated
In addition to thumb ligament surgery, Dr. Neustein treats:
- Radial collateral ligament tears
- Trigger finger release and tendon ruptures
- Thumb arthritis and CMC joint reconstruction
- Carpal tunnel and cubital tunnel syndromes
- Wrist sprains, scaphoid fractures, and other ligament injuries
When to Seek Care
You should see a hand specialist if you notice pain, swelling, or instability in the thumb joint after an injury. Early evaluation allows the ligament to be treated properly and prevents long-term complications.
Schedule an appointment if you have:
- Persistent thumb pain or tender swelling
- Weakness when gripping or pinching
- Thumb instability or popping sensations
- Limited range of motion or stiffness
Prompt diagnosis and treatment will facilitate healing and help you regain full use of your hand.
Schedule an Appointment
If you have sustained a thumb UCL injury or torn ligament and want to regain full motion and strength, schedule a consultation with Dr. Thomas Neustein today. Expert care at Specialty Orthopaedics ensures your thumb and hand are restored to optimal function.
