Thumb sprains can be mild to severe. They are ranked by how much the ligament is pulled or torn away from the bone.

• Grade 1: Ligaments are injured, but there is no instability. This is a mild injury. You may need to wear a splint or other immobilization device, and once your injury starts to heal, your provider may prescribe gentle stretching or exercises.
• Grade 2: Ligaments are partially torn. This injury may require wearing a splint or a cast for several weeks.
• Grade 3: Ligaments are completely torn, and your joints are unstable. This is a severe injury that may require surgery.

Injuries that are not treated properly can lead to long-term weakness, pain, or arthritis.

An x-ray may also show if the ligament has pulled off a piece of bone. This is called an avulsion fracture.

Common symptoms are:

• Pain
• Swelling
• Bruising
• A weaker pinch or problems grabbing things when you use your thumb

If surgery is needed, the ligament is reconnected to the bone.

• Your ligament may need to be reattached to the bone using a bone anchor.
• If your bone is broken, a pin will be used to put it in place.
• After surgery your hand and forearm will be in a cast or splint for 6 to 8 weeks.

Make an ice pack by putting ice in a plastic bag and wrapping a cloth around it.

• Do not put the bag of ice directly on your skin. Cold from the ice can damage your skin.
• Ice your thumb for about 20 minutes every hour while awake for the first 48 hours, then 2 to 3 times a day.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), aspirin, or acetaminophen (Tylenol). You can buy these medicines without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or bleeding.
• Do not take more than the amount recommended on the bottle.
• Do not give aspiring to children.

As you recover, your provider will check how well your thumb is healing. You will be told when your cast or splint can be removed and you can return to your normal activities.

At some point as you recover, your provider will ask you to begin exercises to regain movement and strength in your thumb. This may be as soon as 3 weeks or as long as 8 weeks after your injury.

When you restart an activity after a sprain, build up slowly. If your thumb begins to hurt, stop using it for a while.

Contact your provider or go to the emergency room right away if you have:

• Severe pain
• Weakness in your thumb
• Numb or cold fingers
• Drainage or redness around the pins, if you had surgery to repair the tendon

Also contact your provider if you have concerns about how well your thumb is healing.

Sprained thumb; Stable thumb; Ulnar collateral ligament injury; Gamekeeper's thumb

Schoener B, Wagner MJ. Hand injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 42.

Yao J. Dislocations and ligament injuries of the digits. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 8.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.