What Is Skier’s Thumb?
Skier’s thumb also known as gamekeeper’s thumb is a tear to the ulna collateral ligament/ UCL. This ligament is commonly injured as the result of a sudden ulnar-deviating or hyperextending force applied to the thumb by the straps of a ski pole during a fall, which is where the injury draws its name from.
With Skier’s thumb the UCL may be torn, damaged or in some cases avulsed from its insertion site (pulled form the bone). The patient with a skier’s thumb will complain of pain over the ulnar side of the thumb knuckle closest to the wrist joint, this is the side of the thumb when you palm is facing forwards that is closest to your body and there may be some localised swelling and tenderness when touching the area. The long term problem with an untreated skier’s thumb is pain and weakness, which is at its worst during activities involving a pinch grip, where the UCL is crucial in stabilising the thumb joint at the knuckle closest to the wrist.
Management Of Skier’s Thumb Injuries
History of injury, a thumb X ray and appropriate stress testing to the UCL (clinical stability testing) is key to making the diagnosis of UCL injury. Patients with a skier’s thumb injury that indicates the need for surgical repair should be promptly sent to visit an orthopedic hand surgeon to make sure receiving the correct treatment isn’t delayed.
Lower grade skier’s thumb injuries such as grade 1 and 2 UCL injuries can be successfully treated conservatively (meaning nonsurgically) with immobilization around six weeks followed with physiotherapy to help restore movement and strength to the area. Ideally the joint should be protected from full stress for 3 months after injury meaning a delay in returning to high risk sports and loading activities.
Surgery For Skier’s Thumb
Surgical repair is indicated in the following situations:
• A complete ulna collateral ligament rupture.
• The presence of displaced or large avulsion fractures.
To prevent chronic painful instability, weakness of pinch grip, and arthritis, surgical treatment is recommended in the above situations. Following surgery the patient with skier’s thumb can be guided by their physiotherapist in the use of stretching exercises to assist with a full return of ROM. Also, strengthening exercises can be used to help the return of strength and full function. The strengthening program should be well rounded but should also focus particularly on the strength components that are necessary to the individuals particular sport.
Returning To Sport Following A Skier’s Thumb Injury
Frequently patients wish to return to high risk sports following a skier’s thumb injury in this situation then the patient should have a clear understanding that there is a potential for worsening of their condition from further injury. Where possible protective splinting or taping should be considered with the goal of preventing further injury to the area again a physiotherapist can help guide on the use of taping and bracing for the thumb.
Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Skier’s Thumb should consult his or her physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.