Skier’s Thumb occurs when the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb is injured. This can happen when the thumb is bent back away from the fingers, or hyperextended. It is treated with immobilization or surgery.
This injury was formerly known as Gamekeeper’s Thumb. This was because of the stretching and tearing of the ligament from breaking the neck of small animals during hunting.
The head of the first metacarpal bone and the base of the proximal phalanx in your thumb meet, forming the metacarpophalangeal joint. Ligaments on each side of the MCP joint stabilize it from side to side. The ulnar collateral ligament attaches to the web space side of the metacarpophalangeal joint and is used whenever you hold an object.
Skier’s Thumb Causes
Skier’s Thumb occurs when the ulnar collateral ligament is injured, occurring when the thumb bends back away from the fingers, or hyperextends. Although this motion can happen to anyone, it more commonly occurs in sports.
The ulnar collateral ligament can partially tear or completely tear. This is known as rupturing. If the ligament ruptures and tissue comes between the ligament ends, it is called a Stener lesion. This prevents the ligament from healing without surgery. The ulnar collateral ligament can remain in one piece but pull a piece of bone away from where it attaches at the base of the thumb, or an avulsion fracture.
Skier’s Thumb Symptoms
In most cases, Skier’s Thumb causes pain and swelling. The skin may bruise and appear discolored around the joint. The MCP joint may feel weak when you pinch, grasp, squeeze, or hold objects or move it in any way. A ruptured ligament may form a Stener lesion near the base of the thumb nearer to the palm side of your hand. This will appear as a bump or thickening in the region of the ligament.
Skier’s Thumb Diagnosis
A doctor can diagnose Skier’s Thumb by examining the thumb and ordering X-rays that can reveal an avulsion fracture. Stress X-rays can also aide in the diagnosis by indicating joint instability. You may receive a local anesthetic prior to the test because the X-ray positioning will be painful.
Skier’s Thumb Treatment
If your ligament is partially torn, your thumb may be immobilized with a thumb spica splint or cast. Following the casting, you may need to wear a thumb spica splint during activities for an extended time. Hand therapy rehabilitation can help you strengthen your grip and regain motion.
Skier’s Thumb Surgery
Surgery is usually recommended for complete ligament tears and avulsion fractures. Ligament tears are repaired with sutures. This is in an outpatient surgery. The ligament generally tears from the proximal phalanx. This means the repair involves reattaching the ligament to the bone. There are several methods to do this. Avulsion fractures are repaired with surgical hardware to hold the bone fragments in place. This will be followed by hand therapy rehabilitation.
Delayed treatment for a complete ligament tear usually requires reconstruction of the ligament as well as some type of graft as the condition of the ligament is too poor to allow direct repair.
Skier’s Thumb Recovery
Skier’s Thumb injuries that receive prompt treatment definitely have the best outcomes. A person that receives surgical treatment for Skier’s Thumb can typically resume normal activities in about three months. Skier’s Thumb injuries that are not treated are at risk for a multitude of complications including development of arthritis and chronic instability.
Skier’s Thumb Prevention
You will be able to prevent further injury and impairment by receiving prompt medical treatment for Skier’s Thumb injuries. Injuries that receive earlier treatment always tend to have the best outcomes. You should adhere to the splint-wearing schedule ordered by your doctor and perform your home exercise therapy program, per your doctor’s orders.