Injury, Int. J.

Care Injured 34 (2003) 535–536

Case report
The danger in a handshake—an unusual case of ulnar
collateral ligament rupture
Ramita Dey∗ , A.D. Green
Department of Orthopaedics, Noble’s Hospital, Douglas, Isle of Man, UK

Accepted 24 January 2002

1. Background

Rupture of the ulnar collateral ligaments of the thumb are

common athletic injuries [1,2]. Originally described in Scot-
tish gamekeepers, who sustained the injury by breaking the
necks of injured hares, ulnar collateral ligament injury now
most often and with increasing frequency occurs in skiers
who fall holding onto ski poles, resulting in the term “skier’s
thumb” [3]. It is also very common among basketball players
and in grappling sports like wrestling and the martial arts.
We describe a tear of the ulnar collateral ligament caused
by a trivial force and occurring in the unusual and unique
situation of a simple handshake.

2. Case report

A 47-year-old previously fit jeweller attended A&E with

sudden onset severe pain and swelling of his right thumb. He
had been at a meeting and had reached behind a colleague to
shake hands with the next person. On clasping hands, he felt
a sudden, severe pain in his right thumb. Swelling around
the joint set in rapidly and he noticed that the thumb was
“pointing away” from his hand. On examination, the thumb
was swollen, painful on motion and radially deviated. The
point of maximum tenderness was found to be on the ulnar
aspect of the thumb metacarpophalangeal joint.
Radiographs showed no fractures (Fig. 1) but examination
under local anaesthetic showed ulnar instability of the same
joint.
He underwent an exploration and was found to have com- Fig. 1.
plete rupture of the ulnar collateral ligament of the thumb
(Fig. 2). This was surgically repaired and he was discharged
the same day in a cast. After 4 weeks, a removable cast
∗ Corresponding author. Address for correspondence: 27 St. Andrew’s
was applied and mobilisation and physiotherapy com-
Street, Liverpool L3 5XZ, UK. Present address: Alder Hey Children’s
menced. At the time of the report, 2 months following the
Hospital, Eaton Road, Liverpool L12 2AP, UK. Tel.: +44-151-7091922. injury, he had regained satisfactory range of motion of the
E-mail address: ramitadey@hotmail.com (R. Dey). thumb.

0020-1383/02/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 2 0 - 1 3 8 3 ( 0 2 ) 0 0 0 3 2 - 3
536 R. Dey, A.D. Green / Injury, Int. J. Care Injured 34 (2003) 535–536

usually with associated hyperextension, resulting in partial

or complete tearing of the ligament, and frequently associ-
ated with injury to the volar plate [4]. A considerable force
is usually involved, as applied by gamekeepers in breaking
the neck of hares, or the force of a fall transmitted through
a ski pole to an abducted thumb.
In our case, detailed analysis demonstrated that during
the handshake, while “reaching across”, the patient’s thumb
had first impinged on his colleague’s palm, before inter-
locking into the first web space as in a standard handshake.
The biomechanics of the commoner sports injury had been
recreated, consequently rupturing the ligament.
The tear was repaired surgically, which is the treatment
of choice for complete rupture [5], and has resulted in sat-
isfactory recovery, especially relevant to his profession.
Ulnar collateral ligament tears are usually associated with
sports injuries. However, as our case demonstrates, it can
occur, involving trivial force, under very different circum-
stances, underscoring the importance of awareness and de-
tailed history taking.

References

[1] Heyman P, Gelberman RH, Duncan K, et al. Injuries of the

ulnar collateral ligament of the thumb metacarpophalangeal joint—
biomechanical and prospective clinical studies on the usefulness of
valgus stress testing. Clin Orthop 1993;292:252–5.
[2] Ritchie JW, Munter DW. Emergency department evaluation and
Fig. 2. treatment of wrist injuries. Emerg Med Clin North Am 1999;17:793–
822.
[3] Morgan JV, Davis PH. Upper extremity injuries in skiing. Clin Sports
Med 1982;1:295–308.
3. Discussion [4] Perron AD, et al. Ulnar collateral ligament rupture. Am J Emerg Med
2001;9:1.
[5] Arranz Lopez J, Alzaga F, Molina J. Acute ulnar collateral ligament
Ulnar collateral ligament tear is usually caused by a injuries of the thumb metacarpophalangeal joint: an anatomical and
sudden, forced radial deviation (abduction) of the thumb, clinical study. Acta Orthop Belgique 1998;64(4):378–84.