SKIER’s THUMB

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 or 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.

Causes and risk factors

  • Trauma causing hyperextension of thumb
  • Commonly related to falls, especially while holding something in the hand such as a ski pole
  • Chronic instability may arise from repetitive injuries

Symptoms

  • Pain, swelling, bruising along the thumb
  • Weakness with pinching/gripping
  • Instability to the thumb

Diagnosis and treatment

In most cases, 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 nonsurgically 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 nonsurgically depending on the pattern of tear and patient goals. Left untreated, complete tears can lead to chronic pain, weakness and instability of the thumb.