Skier’s thumb is a name given to sprains and tears of the ulnar collateral ligament of the thumb near the metacarpal phalangeal joint (MCP joint). These injuries occur after a fall if the thumb is forced away from the hand, such as falling with a ski pole. These injuries may also be chronic and due to repetitive stress on the ligament. When that is the case, the injury is considered a gamekeeper’s thumb.
Patients who have an injury to the ulnar collateral ligament of the thumb typically present to our clinic after a fall in the snow, or while cycling. The thumb has been bent forcefully resulting in an injury to this ligament. Patients with Skier’s thumb will have tenderness and swelling on the inner side of the thumb. Movement of the thumb, especially pinching and gripping, can be painful or weak. Range of motion can also be decreased because of swelling and pain.
Ligaments attach one bone to another. They span a joint, and allow the bones to move, within a restricted plane of motion. The MCP joint in the thumb is stabilized by ligaments on either side of the joint. When this ligament experiences a powerful stress it can partially tear or completely tear. When the tear is complete, the ligament often balls up under the skin. This is called a Stener lesion.
Skier's Thumb Treatment
Treatment for skier’s thumb will depend on the severity of the injury. Partial tears can be treated in a cast or brace for 4-6 weeks. When the ligament is torn completely and there is a Stener lesion present, surgical management is recommended to achieve an optimal outcome. Complete tears that are treated in a cast oftentimes do not heal, resulting in long term weakness, particularly with pinch or grip.
After surgery, a splint will be worn for the first two weeks to allow proper healing of the ligament. At that point patients are placed into a cast for an additional two weeks. After the cast comes off, a removable brace will be worn for two more weeks. About 50% of our patients will require physical therapy to gain full thumb range of motion. Most patients are mostly better by 10-12 weeks and fully recovered by 4 months after surgery.