Marc Tanner, MD
Piedmont Orthopaedic Associates
Skier's Thumb is an injury of the ligament that connects the bones of your thumb together, called the Ulnar collateral ligament. It most often happens when a skier falls on an outstretched hand that is holding a ski pole, causing the thumb to land on the pole and bend at an awkward angle. Keep in mind though, that while it's called Skier's Thumb or Game Keepers Thumb, this condition can be caused by any injury that causes the thumb to be bent in a similar way.
Usually this injury results in a sprain that heals over time, but it can occasionally completely tear the ligament and need surgical repair. If left untreated, the ability to grasp between thumb and forefinger can be noticeably weakened.
How to Know if You Did It
You will probably know you damaged this ligament right after the fall. There is often immediate swelling and pain in the base of the thumb. Most telling is tenderness along the web area between the thumb and index finger, and a weakened grasp between your thumb and index finger. Bruising may develop in a few days. For those cases that are not diagnosed early, there may be a thickening at the base of the thumb joint, along with chronic swelling.
What to Do If You Did It
It is important to get this type of injury checked out by a doctor right away, because the ability to pinch small objects between the thumb and the index finger is often severely impaired because of the instability of this joint.
Until you can get to a doctor, apply ice to the area and use wraps to compress it. Pain can be controlled with NSAID pain relievers.
Your doctor will take X-rays of the area and examine your hand to determine how stable the joint is. If the joint is unstable, the ligament has probably been torn. If the joint appears stable, it's most likely a ligament sprain.
If your doctor diagnoses your injury as a sprain, he or she will immobilize the thumb in a cast or splint for six weeks. Physical therapy is important to help gain mobility in this type of injury, and your doctor will probably prescribe several weeks of therapy after your cast or splint is removed. Most skiers can return to skiing after about 10-12 weeks if rehabilitation was successful.
There are several reasons this type of injury may require surgery. If the ligament has completely ruptured, if a fragment of bone was pulled off during the injury, or if joint instability still occurs after conservative treatment, surgery may be needed. There are several specific surgical methods, but essentially the damaged ligament is set back in place using suture devices. Following surgery, the thumb is immobilized for about six weeks. Once the cast or splint is removed, physical therapy begins to help regain range of motion and rebuild strength.
Fortunately, it's easy to prevent this injury this ski season: just remember "Thumbs Up" when putting on your ski poles. Hold the strap horizontally, then put your hands up through the loop and grab the pole handle. The strap should be between your hand and the pole so you hold both together. This way, when you fall or let go, the pole will fall away from your hand.
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