Skier’s Thumb is a common injury, especially in active individuals. Skier’s thumb, also known as “gamekeeper’s thumb”, involves an injury to the ligament on the inside of your thumb – the ulnar collateral ligament (UCL) of the metacarpophalangeal joint. This injury can involve a sprain in which case the ligament stretches, partially tears, or a complete tear leading to significant pain, weakness, and instability of the thumb. The injury occurs most commonly from an acute traumatic event leading to hyperextension of the thumb.
Skier’s thumb is most common in sports or falls. The thumb can be jammed against another player, ground, ball, or overly bent where one or more ligaments can tear. For example, overly extending your thumb on a ski pole can injure the ulnar collateral ligament.
With a sprained thumb, the thumb and/or hand usually swells and bruises. You may have pain or weakness while pinching or grabbing. If you experience this instability with your thumb, contact your hand surgeon for further diagnosis.
Mild thumb sprains usually improve with home treatment including anti-inflammatory medicine and the RICE protocol:
Rest: Stop using your hand. Protect the area, and avoid any activity that is painful or may have caused the injury. Continued activity could cause further damage.
Ice: Use ice for the first 48-72 hours after an injury. Apply ice several times a day for 20 minutes at a time, followed by one hour “off.” The cold will contract injured capillaries and blood vessels to help stop internal bleeding. Do not apply ice directly to the skin.
Compression: Wrap your hand firmly with an elasticized bandage, compression sleeve, or cloth – especially when you are more active. This will help speed up healing time by reducing swelling around the injury.
Elevation: Elevate your hand above the level of your heart to decrease swelling and joint pain.
If your pain persists, x-rays are obtained to ensure there is no fracture to the thumb. Most of the time, the diagnosis can then be made clinically based on your exam and symptoms. Occasionally, advanced imaging such as an MRI will be obtained to evaluate the extent of the tear and help determine treatment options.
Treatment depends on the extent of injury to the ligament. In most cases, UCL injuries are treated non-surgically with immobilization, often by casting and then transitioning to a removable brace. In general, it may take up to three months to fully recover and return to normal activity after a sprain/partial tear of the ulnar collateral ligament. Complete tears may be treated surgically or non-surgically depending on the pattern of tear and patient goals. Left untreated, complete tears can lead to chronic pain, weakness, and instability of the thumb.
Falls and accidents can happen very quickly, so preventing a UCL injury can be difficult but learning to fall safely is invaluable. If you fall holding a ski pole or similar object, try to let go of it to avoid landing on it and injuring ligaments.
Watch this quick video of orthopedic surgeon and hand specialist, Dr. Soma Lilly, explaining skier’s thumb.