Hitting the Slopes this Holiday Season? Don’t Get Caught with Skier’s Thumb

An age-old hand injury now associated with modern day sports

This time of year the adventures that beckon include snow packed peaks and winter white trails. To ensure success on the slopes, learn how to avoid a common hand injury that could end your run and holiday fun early; “Skier’s thumb.” Skier’s thumb is among one of the more common hand injuries associated with these winter sports.  If not properly treated it can affect “pinch and grip” strength, hindering overall hand function and predisposing the joint to chronic instability and osteoarthritis.

What is Skier’s Thumb

Skier’s Thumb, UCL Damage of the Thumb’s MCP Joint

Skier’s thumb, which is also referred to as a thumb sprain or “Gamekeeper’s thumb,” is an injury to the ulnar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MCP) joint.  It is the result of forced abduction or hyperextension of the proximal phalanx of the thumb, caused by abnormal pulling of the thumb, such as in a fall, while affixed to the ski pole/hoop.  While this type of injury is often seen among skiers, it is also frequently seen in athletes or those sustaining a fall on an outstretched hand.

The term “Gamekeeper’s thumb” was first coined in 1955 by CS Campbell, who identified UCL injuries as an occupational disease in Scottish gamekeepers. The gamekeepers strangled rabbits using their thumb and index finger, and the repeated valgus stresses resulted in UCL injury and chronic instability of the MCP joint [1]. In the present day, this lesion occurs more frequently in acute sports-related injuries like skiing.

Signs of Injury to the Ulnar Collateral Ligament Include:

  • Pain at the base of the thumb between the thumb and index finger
  • Swelling of the thumb
  • Weakness pinching or grasping
  • Tenderness along the index finger side of the thumb
  • Blue or black discoloration of the skin over the thumb
  • Thumb pain that worsens with movement in any or all directions

Diagnosing Skier’s Thumb

A physical examination and patient history are used in diagnosing this condition. To determine the extent of damage to the UCL, the thumb is moved in various positions to assess stability of the thumb joint.  A stress x-ray may be recommended to confirm that there are no broken bones.

Treatment and Rehabilitation for Skiers Thumb

Treatment for Skier’s Thumb depends on the extent of the damage.  Most cases respond well to conservative, nonsurgical treatment, which may entail immobilization in a cast initially – followed by a splint for a total of six weeks.

If the UCL is completely torn, surgery may be indicated to reconnect the ligament to the bone and restore range of motion and full thumb function.  Any bone damage that occurred during the tear is also repaired during this time.  Following surgery, patients are put in a splint and undergo range of motion exercises with protected activities for four to six weeks. This is then followed by conditioning and strengthening of the thumb.

References

  1. Hung CY, Varacallo M, Chang KV. Gamekeepers Thumb. StatPearls. (Last updated Aug 11, 2021) https://www.ncbi.nlm.nih.gov/books/NBK499971/ .

 Dr. Korsh Jafarnia is a Houston board-certified, fellowship trained orthopedic surgeon specializing in the hand, wrist and elbow. He is a published author and recognized locally and nationally as a “top doctor” in his field, who is highly sought for his level of expertise in hand and upper extremity orthopedic care.