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Ulnar collateral ligament repair (first MCP joint)
UCL repair or reconstruction treats a torn ulnar collateral ligament at the base of the thumb, commonly known as skier’s thumb, an injury that destabilises the thumb’s grip and pinch strength. Surgery reattaches or reconstructs the torn ligament to restore joint stability and prevent chronic weakness or arthritis from an untreated tear.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately two weeks after surgery
Driving
Not until out of splint/cast and you have adequate thumb strength and control - plan not to drive for 6-8 weeks after surgery
Post Operative Hand Therapy
Required for splinting, and for rehabilitation after splint removal to restore thumb movement, strength and pinch grip
Splinting
Yes - a thumb spica splint or cast is worn for 8 weeks after surgery to protect the repair
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 8 weeks before resuming sport or activities that stress the thumb
Repair or reconstruction of the ulnar collateral ligament of the thumb MCP joint
This surgery repairs or reconstructs the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal (MCP) joint, most often torn from a fall onto an outstretched thumb (a ski pole injury, hence “skier’s thumb”) or from a forceful sideways stress to the thumb.
Who is this procedure for?
- People with a complete ulnar collateral ligamenttear causing instability of the thumb MCP joint, confirmed on examination and imaging
- People with a Stener lesion, where the torn ligament end becomes displaced above the adductor aponeurosis and cannot heal on its own without surgery
- People with a large bony avulsion fragment displaced from the joint
- Not usually needed for a partial tear with a stable joint, which can often be treated with splinting alone
What does the surgery involve?
Surgery involves an incision over the ulnar side of the thumb MCP joint to identify the torn ligament. If the ligament tissue quality allows, it is repaired directly back to its bony attachment, using a suture (also called a ‘bone’) anchor that is secured to the bone.
If the ligament is too damaged or the injury is longstanding (chronic laxity), reconstruction using a tendon graft may be required to recreate the ligament; this is uncommon.
A bony avulsion fragment, if present, may be fixed with a small screw instead of, or in addition to, ligament repair. If the bone fragment is too small to accommodate a drill hole and screw then a bone anchor is applied.
Alternatives to surgery
Surgery is one option for a UCL injury of the thumb. Depending on your situation, the alternatives may include:
- Splinting or casting alone: appropriate for a partial tear with a stable joint on examination
- Direct repair versus reconstruction: depends on the quality of the remaining ligament tissue and whether the injury is acute or longstanding
What happens if left untreated: an untreated complete UCL tear, particularly with a Stener lesion, will not heal on its own and typically leads to chronic instability of the thumb, weak pinch grip, and early arthritis of the joint.
Dr Tomlinson will discuss which options suit your specific injury at your consultation. Non surgical treatment is not recommended when there has been a complete tear of the ligament.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based, you may return within one to two weeks with the thumb splinted. If your work requires pinch grip or thumb loading, you’ll usually need 8 weeks or longer if alternate or modified duties are not available. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You must be safely in control of the vehicle for insurance purposes – you must be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six to eight weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 1-2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A thumb spica splint or cast is typically worn for 8 weeks after surgery to protect the repair or reconstruction while it heals.
Will I need to see a hand therapist afterwards?
Yes. Initially you must see a hand therapist to be fitted with a custom splint that immobilises the MCP joint and protects the ligament repair. Hand therapy is recommended once the splint is no longer needed, to restore thumb range of motion, strength, and particularly pinch grip, which relies heavily on a stable MCP joint.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Numbness or tingling over the thumb from irritation of a small sensory nerve branch that runs through the surgical field; this altered sensation is extremely common in the early weeks, and is expected to gradual recovers but could remain altered in the long term.
- Stiffness of the thumb if exercises are not resumed as advised
- Residual or recurrent instability of the joint, especially with premature return to motion or activity; long term this can predispose to joint arthritis and weak pinch grip
- Longer-term risk of arthritis in the joint
- If a graft or button/suture anchor is used: infection or gradual loosening of the fixation
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. You will be in a cumbersome plaster and bandage dressing to protect the ligament repair.
First week
Keep the dressing dry and intact. You may use your hand for light activities, but should avoid lifting objects greater than 300 grams in weight. It is common to notice altered sensation along the dorsal ulnar portion of the thumb once the local anaesthetic wears off. You will see a hand therapist at approximately one week to be placed in a custom fitted thermoplastic splint that permits movement of the end joint of your thumb, but not the treated MCP joint.
Second week
The thumb remains in a splint or cast to protect the repair. Movement of the other fingers is encouraged; the thumb MCP joint itself is kept immobilised. At four weeks your hand therapist will start you performing range of movement exercises (flexion and extension) of the surgically treated joint.
8 weeks
You can cease wearing your splint and commence strengthening exercises. Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle. Strength is increasing and there are no lifting or loading restrictions.
Long term
The splint is typically removed around 8 weeks, followed by a period of hand therapy to regain movement and strength. Return to contact sport or activities that stress the thumb is usually deferred until around 3 months.
Want to know more about UCL Repair/Reconstruction of the Thumb MCP Joint (Skier’s Thumb)?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.