Skier's Thumb

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Skier's Thumb Facts

  • Skier's thumb is an injury of the soft tissue that connects the bones of the thumb together. In medical terms, this soft tissue is called a ligament.
  • This injury was originally noted in 1955 as a chronic ligament problem seen in Scottish gamekeepers who damaged their thumbs by repeatedly twisting the necks of hares. The injury was termed the "gamekeeper's thumb" at that time.
  • The popularity of recreational downhill skiing has caused this injury to become much more common in the U.S.; as a result, the term gamekeeper's thumb was replaced with the more contemporary term, skier's thumb.
  • Skier's thumb now accounts for a significant number of skiing injuries.
  • In severe cases, with complete tearing of the ligament, this injury must be surgically repaired.
  • The ultimate stability of the ligament is important because of its contribution to the grasping function of the thumb.
  • People with skier's thumb may be able to return to work and even skiing in a short period with proper rehabilitation.

Skier's Thumb Causes

Skiing accidents are the most common causes of damage to the ligament that cause the injury known as skier's thumb. Injuries of this ligament make up 8%-10% of all skiing accidents.

  • More specifically, a fall on an outstretched hand with a ski pole in the palm of the hand creates the force necessary to stress the thumb and stretch or tear the ligament.
  • A simple fall on an outstretched hand with an empty palm usually does not create this same force. However, the thumb can also be injured if it jams into packed snow at high velocity.
  • Another less common cause of this injury is an automobile crash when the driver has the thumb alone draped over the steering wheel.
  • Any injury in which the thumb is abnormally bent backward or to the side can cause skier's thumb.

Skier's Thumb Symptoms

These signs and symptoms may occur minutes to hours after the fall that created the injury.

  • Pain at the base of the thumb in the web space between thumb and index finger
  • Swelling of the thumb
  • Inability to grasp or weakness of grasp between the thumb and index finger (most important)
  • Tenderness to the touch along the index finger side of the thumb (most important)
  • Blue or black discoloration of the skin over the thumb
  • Thumb pain that worsens with movement in any or all directions
  • Pain in the wrist (which may be referred pain from the thumb)

When to Seek Medical Care

If a person experiences any of the symptoms of skier's thumb following an injury, call a doctor as soon as possible. Follow the doctor's instructions about special home care considerations and find out when the thumb can be checked.

If a person determines that skier's thumb is possible, considering the way your accident happened, then the injured person should be taken by car to a hospital's emergency department. There is no need to go by ambulance unless that is the only means of transportation or there is another more serious injury associated with the accident.

An alternative to the emergency department would be an office visit to an orthopedic surgeon (bone specialist) or hand surgeon's clinic. If an orthopedic surgeon is available to see the patient on the day of the injury, it is more efficient to go see the surgeon directly instead from the emergency department's referral.

Skier's Thumb Diagnosis

The physician will first determine whether or not the patient has other limb-threatening injuries and then evaluate the thumb in more detail.

The doctor will ask the patient how the injury happened. The patient will be asked the following questions:

  • At what time did the injury take place?
  • What was the exact positioning of the hand and thumb during the injury?
  • How soon after the injury did the pain and swelling begin?
  • Did it feel as if the thumb was stressed beyond its normal range of motion?

The doctor will also ask about the patient's past medical history. The patient will be asked the following questions.

  • Have you ever suffered from a similar injury before?
  • Have you ever had any type of surgery in your hand or wrist?
  • Are you allergic to any pain medications?
  • Have you ever fractured any bones in your wrist or hand?
  • Are you right-handed or left-handed?
  • What is your primary occupation?

The doctor will then perform a physical examination.

  • Testing the laxity (looseness) of the ulnar collateral ligament of the thumb: This test will be done by holding the base of the thumb in a fixed position, while applying a lateral (sideways) force on the tip of the thumb to see how many degrees it will move. This movement will be compared to the movement of the other, uninjured thumb. Pain may make this difficult to do immediately after the injury (in which case the injury may be treated and then reexamined in a few days).
  • Assessing for normal functioning of the three major nerves in the hand
  • Checking for point tenderness over certain bony spots of the hand that may indicate fracture
  • X-ray of the hand to make sure no bones are broken
  • Examining the rest of the arm for any associated injuries to your wrist, forearm, elbow, and shoulder

Skier's Thumb Self-Care at Home

If you suspect that you may have a skier's thumb, then home care should address the pain and swelling of the thumb. Take the following steps to minimize your pain and swelling.

  • Apply ice to the thumb for 35 minutes at a time, up to four times per day. Do not apply ice directly to the skin. Continue to use ice until the pain stops. (A doctor should be seen as soon as possible after the injury and then follow a doctor's directions for ice therapy.)
  • Avoid movement of the thumb as much as possible. The loose application of an ACE wrap or commercially available wrist brace in the neutral position will help immobilize the thumb. This will help lessen the pain.
  • Take acetaminophen for pain relief or ibuprofen for anti-inflammatory action. Avoid both of these over-the-counter drugs if you have stomach problems and cannot tolerate them.
  • The most important aspect of home care is to ensure that the injury is fully evaluated by an emergency doctor, orthopedic surgeon, or a primary care physician in the first few days.

Skier's Thumb Treatment

If the doctor determines that the patient has a skier's thumb, then referral to an orthopedic or hand surgeon will be the next step in care. The orthopedic surgeon will determine when the thumb needs to be reexamined. At that time, the patien'ts options for surgical versus nonsurgical therapy will be discussed.

Typically, partial injuries to the ulnar collateral ligament are immobilized for several weeks, while complete rupture of the ligament usually requires surgical repair.

Skier's Thumb Surgery

If the patient elects to have surgery, then operative exploration and ligament repair using a "suture anchor" will most likely be performed. After the operation, the hand may be placed in a lightweight cast to hold the thumb still while the ligament heals. The patient will have to remain in this cast for some time based on the orthopedic surgeon's preferences, although some surgeons now advocate early gentle motion.

If the patient has an associated fracture with skier's thumb, then it may be treated with a modified cast. Surgical stabilization of the fracture might be needed if a piece of bone has broken off in an unacceptable place.

Skier's Thumb Follow-up

The orthopedic surgeon will see the patient after surgical repair or after a period of immobilization in a cast. The patient's thumb will be reexamined. The doctor will decide if the patient need to continue to immobilize the thumb or if physical therapy is needed to regain movement. The remainder of the rehabilitation and the management of any chronic problems that may arise from the injury will be addressed by your orthopedic or hand surgeon.

Skier's Thumb Prevention

  • Skiers should be taught to consciously discard the ski pole during all falls. Falling onto an outstretched hand while skiing without the ski pole in hand should minimize the chance of injury.
  • Skiers should also be encouraged to use poles with finger-groove grips without any restraining devices such as a wrist strap or closed grip.
  • You can prevent skier's thumb during a motor vehicle accident by keeping your thumbs on the outside of the steering wheel along with your fingers. This new routine will require a conscious effort because most drivers are taught to grip the steering wheel in a fashion similar to a ski pole.

Skier's Thumb Prognosis

  • Acute partial rupture of the ulnar collateral ligament can be treated effectively with four weeks of immobilization in a special cast. Healing with full recovery is the rule with partial ruptures.
  • With a total rupture, either immobilization or surgical repair can result in partial or full recovery with the potential for long-term complications, including chronic pain and instability of the joint.

Skier's Thumb Pictures

Skier's thumb. Fall on outstretched hand after discarding ski pole. Skier's thumb is unlikely with this mechanism of injury.
Skier's thumb. Fall on outstretched hand after discarding ski pole. Skier's thumb is unlikely with this mechanism of injury.

Skier's thumb. Fall on outstretched hand with ski pole in palm of hand. Skier's thumb is possible with this mechanism of injury.
Skier's thumb. Fall on outstretched hand with ski pole in palm of hand. Skier's thumb is possible with this mechanism of injury.

Reviewed on 11/17/2017

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCE:

MedscapeReference. Skier's Thumb.

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