I asked (on GP-UK and an orthopod mailing list):

Can anyone remember why a gamekeeper's thumb is so-called?
(ulnar collateral ligament rupture)
(aka Skier's Thumb - why?)

What did gamekeeper's do to cause this?
twist the heads off gamebirds?
Break their necks?

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Adrian Midgley replied:

Pull back the hammers of the shotgun, using the thumb.

Develops a lot of wear and tear.

Skiers can catch a thumb as they go down, particularly in 
the off season on the honeycomb matting - Hill End thumb
from Edinburgh's Hill End artificial ski slope.

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Prit Buttar replied:

Quite correct - throttling pheasants, I believe.

I remember a heated debate on this subject, with the
consultant suggesting that it was due to cocking a shotgun
hammer, while his very academic registrar retaliated by
finding a reference to it that predated the advent of
percussion caps in shotgun cartridges.

=========================

Adrian Midgley replied:

Which were an improvement on the flintlock, cocked by 
pulling back a spring-loaded (more so than percussion cap
fired arms) moving part which scraped a flint on a steel to
shower sparks into the pan of powder.

Before that there was the matchlock which just stuffed a
lit bit of string into the pan.

Percussion caps not relevant, but if gamekeepers were noted 
to get it before firearms...

I suppose like all these things it is gamekeepers thumb if
the thumb is on a gamekeeper, whereas if not it is a
ruptured ligament.

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Darragh Hynes replied:

I believe that the reasaon for the eponym was that Gamekeepers broke
fowl and rabbits' necks by holding the unfortunate beast by the hind
legs and then running the hand over the back of the neck, catching the
head between the thumb and the index finger i.e. in the first web. This
sudden distraction then broke the animals neck. Doing this on a
repetitive basis, caused a CHRONIC stretching injury of the ulnar
collateral ligament. This is a different injury from the acute injury
which we see now, for which the slopes of Klosters etc are more
responsible. 

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Jan Van Der Bauwhede replied:

To my knowledge,
the gamekeepers used to twist the neck of caught foxes to kill them.=20
That chronically made them develop an unstable MCP1 joint by injuring =
the ulnar collateral ligament.

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Richard Strain replied:

When wounded game usually rabbits were killed by dislocation of their neck 
with traction the game keeper would injure the ulnar collateral ligament of 
the thumb metacarpal phalangeal joint. I don't know if they exist today I 
believe they worked for royalty.

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Toby Branfoot replied:

Although I've often heard this described as a chronically developed
condition from wringing necks of birds and animals, I always understood it
actually to have been an injury to the ulna collateral ligament from
setting spring traps ..... opening the fairly powerful jaws uses both
hands with the fingers supporting the body of the trap whilst the
supination and adduction of the thumb levered open the jaws. A slip here
and the thumb can get badly wrenched, giving the thumb an ulna collateral
tear. It may have become chronically lax (and I suppose operative repair
was rare) but I understood the "gamekeepers thumb" reference was to one
population group where it was commonly seen - after all it gets called
"dry ski slope thumb" in casualty departments these days in the UK. A
Canadian I met told me he had heard of it being called "trappers thumb"
..... don't know if any Canadians reading the list can confirm/rubbish
this one.

================================

Louis Solomon replied:

Acute injuries of the ulnar collateral ligament of the thumb were
recognised by GP's and Orthopods alike in the 'thirties and 'forties and
are described in one of the early editions of Watson Jones.  In 1955
Campbell drew attention to the fact that a similar 'stretching' of the
ligament occurs quite commonly as a chronic occupational lesion in
gamekeepers.  There are two excellent photographs in his original
article showing how this comes about (JBJS 37B, 148, 1955).  By the way,
gamekeeping may be a dying profession but I have seen the conditions
several times in farmers. 

Happy hunting!

==================================

Albert B Accettola replied:

Gamekeepers managed the game on country estates and hunting preserves.  One
of their traditional duties was to skin the rabbits after the hunt.  Rabbits
are skinned by making an incision around their hind legs, tail, and anus,
then sticking your thumb in the incision and pulling the skin down off the
body and over the neck to the head.  This repetative stress on the ulnar
collateral ligament causes the injury.
Today the injury is seen more commonly as a skiing injury.



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