Skier’s Thumb

A “skier’s thumb” is an injury to the ulnar collateral ligament of the thumb. This ligament is an important attachment between the thumb proximal phalanx and metacarpal bones. Sometimes this ligament sprains or tears following a fall onto the thumb. If the thumb is bent backwards or forced to the side (such as when falling with a ski pole in one’s hand), the ulnar collateral ligament may abruptly tear. However, sometimes the ligament slowly stretches out and fails over time, this injury is then referred to as a “gamekeeper’s thumb”.

Thumb anatomy.png

A thumb with a torn ulnar collateral ligament will be painful, oftentimes swollen, feels week, and is difficult to bend normally. The pain tends to be worse when pinching or grasping items, such as a holding a coffee cup, a doorknob or a pencil.

The severity of a thumb sprain can usually be determined by an orthopaedic or hand physician, who will test the stability of the injured thumb compared to your uninjured or normal side. X-rays can be helpful to assess for fractures, and in some cases an MRI may be obtained to visualize the ligament.

Low-grade thumb sprains will usually heal in a brace. Normal ligament healing typically takes around ~6-8 weeks. A thumb spica splint or brace is usually worn full time for 4 weeks, then part time (such as for activities, lifting, or when sleeping) for another 4 weeks.

High-grade tears, or more complete ligament injuries, especially those resulting in the thumb being unstable, may be treated surgically. The torn ligament is sutured back in place. Approximately 90% of the time the ligament is torn from the proximal phalanx, and 10% of the time from the metacarpal bone. A suture anchor is typically used to hold the suture and ligament back to the bone. This is an outpatient procedure, done through a ~1 inch incision, which takes ~30 minutes. Afterwards, a splint is worn full time for ~4 weeks and part-time for another ~4 weeks. Typically normal motion is restored, and pain is eliminated.

A suture anchor is placed into the proximal phalanx. The attached sutures allow for the torn ligament to be stitched back down to the the bone. Image from AO Foundation.

If a skier’s thumb, or ligament tear is not diagnosed or treated, the pain and weakness continues to be present, and can oftentimes result in arthritis.

Read more about thumb sprains here.

Dr. Schreiber in the news- E-scooter injuries are on the rise

Dr. Schreiber in the news- E-scooter injuries are on the rise

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