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Ligament Injuries
A ligament connects bone to bone and stabilises a joint against sideways or twisting force. Melbourne Hand Surgery treats ligament injuries of the thumb, fingers and wrist. Many partial tears settle well with splinting alone; more significant or complete tears often need surgical repair or reconstruction.
What is it?
The thumb, fingers and wrist are stabilised by a number of ligaments, and any of them can be injured. The right treatment depends on which ligament is involved, which joint it stabilises, and whether the tear is partial or complete. Because the answers differ so much between joints, the detail sits on separate pages. Use the links below to go to the page that matches your injury.
Ligament injuries that we treat include
- Ulnar collateral ligament rupture of the 1st MCP Joint (Gamekeeper’s / Skier’s Thumb) Thumb pain and instability at the base of the thumb after a fall onto an outstretched thumb, classically while holding a ski pole. The most common thumb ligament injury.
- Radial Collateral Ligament (RCL) Injury of the 1st MCP Joint (Thumb) An injury to the ligament on the opposite side of the same thumb joint, usually from a direct blow or a fall that forces the thumb inward toward the palm. Less common than the injury above.
- Collateral Ligament Injury (MCP Joints) A sprain or tear of the side ligaments of the knuckle joint at the base of the finger.
- Collateral Ligament Injury of the Finger Interphalangeal (PIP and DIP) Joints A jammed, swollen finger joint after a ball or object strikes an outstretched finger.
- Wrist Ligament Injury and Instability (Scapholunate) An injury to the ligament connecting two of the small carpal bones on the back of the wrist, causing pain and sometimes instability.
This list is not exhaustive. Ligament injuries of the 2nd–5th MCP joints, the carpal bones and the distal radius are also seen and treated but do not yet have a dedicated page. TFCC-related ligament injuries have their own page, not listed here. If you are not sure which applies to you, start with the page closest to where your pain is, or contact us.
At a glance
What is it?
A tear of a ligament that stabilises a joint of the thumb, finger or wrist
Common symptoms
Pain and swelling around the joint, sometimes with bruising, and often a weak or unstable grip or pinch
Who it affects
People who fall onto an outstretched hand or thumb, sustain a direct blow, or jam or twist a finger, often during sport
Is it serious?
Most partial tears settle well, but a complete or unstable tear left untreated can lead to lasting instability or early arthritis
Treatment options
Splinting or buddy taping for partial tears, or surgical repair or reconstruction for complete tears with instability
First step
An examination, often with stress testing and an x-ray, +/- US to determine how severe the tear is
Symptoms and how it presents
The main symptoms are pain and swelling around the affected joint, sometimes with bruising, and tenderness directly over the injured ligament. Grip or pinch is often weak or painful, and a more significant tear can leave the joint feeling unstable or giving way with side-to-side stress.
Causes and risk factors
- A fall onto an outstretched hand or thumb
- A direct blow to the joint
- A jammed, twisted or stubbed finger
- Sporting injuries, particularly ball sports and skiing
- Forceful sideways bending of the joint
How is it diagnosed?
Diagnosis is based on examination, including gently stress testing the joint to check for sideways movement, together with an x-ray to check for an associated small bone fragment. Ultrasound, or occasionally MRI, may be used beforehand to assess how much of the ligament is torn. Diagnosis also considers whether the ligament has torn from its insertion or whether the bone it attaches to has broken instead, since the underlying mechanics are similar but treatment and rehabilitation differ.
Treatment options
Partial tears without instability are routinely treated successfully with splinting, buddy taping, or activity modification under the guidance of a hand therapist, allowing the ligament to heal in position. The duration of treatment and time to return to full activity depends on the severity of the injury and your response to treatment. More significant or complete tears, especially where the joint is unstable, generally need surgical repair or reconstruction, since a fully torn ligament cannot reliably heal back to length on its own.
When to see a hand surgeon
Any injury to the thumb, finger or wrist with pain, swelling and difficulty gripping or pinching after a fall, direct blow, or jamming injury should be assessed, ideally promptly, since a complete tear is often treated more successfully soon after the injury occurs. A jammed finger or a sprained thumb that remains swollen, unstable or painful beyond a week or two should not be assumed to be a minor sprain.
What to expect at your appointment
At your appointment, Dr Tomlinson will examine the affected joint, including stress testing it for stability, and arrange further imaging as indicated. Together you will discuss whether splinting, buddy taping or surgery is the right treatment for your injury. If you have not already been seen by a hand therapist, you will be provided with a referral to one.
Related conditions and treatments
A ligament injury can occur alongside a fracture at the same joint, see hand fractures for injuries affecting the fingers and thumb. A jammed finger can also involve a volar plate injury, a separate but related structure at the same joint. Left untreated, some ligament injuries are a recognised cause of joint osteoarthritis over time.