What is Skier's Thumb?

Skier’s Thumb is a common injury affecting the thumb’s ulnar collateral ligament, often caused by falls while skiing or other sports. This condition leads to pain, swelling, and reduced grip strength. Understanding the symptoms, diagnosis, and treatment options is crucial for a full recovery. This article covers everything you need to know about Skier’s Thumb and how to manage it effectively.

What is Skier's Thumb?

Skier’s thumb is an injury that affects the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal (MCP) joint. This ligament is essential for thumb stability when pinching or gripping objects. When the UCL is damaged, the thumb becomes unstable and painful, making everyday tasks difficult. The injury commonly occurs when someone falls onto an outstretched hand while holding a ski pole, which forces the thumb into an unnatural position. Although often called skier’s thumb, this injury can happen during many other activities that place extreme stress on the thumb.

Skier’s thumb is often confused with gamekeeper’s thumb. The difference lies mainly in how the injury occurs. Skier’s thumb is usually an acute, sudden injury. In contrast, gamekeeper’s thumb develops gradually over time due to repetitive strain and stretching of the ligament. Both can cause similar symptoms, but the causes and treatments may differ.

Causes and Risk Factors

Skier’s thumb occurs mainly because of sudden force that pushes the thumb away from the hand. This is known as hyperabduction or hyperextension. The most common cause is falling on an outstretched hand while gripping a ski pole, which forces the thumb into an unnatural position.

Other common causes include:

• Car accidents where the driver grips the steering wheel tightly and experiences impact.
  
• Sports such as hockey, basketball, rugby, and football that involve catching, holding, or tackling.
  
• Repetitive stress from activities requiring frequent thumb use.
  
• Falls from bicycles or motorcycles, especially when the thumb catches on handlebars.
  
  

Risk factors that increase the chance of injury include poor ski pole technique, using poles with large baskets, and not wearing protective gloves designed to protect the thumb. Men are more likely to suffer this injury than women. Although the name suggests it happens mostly while skiing, only about 10% of cases are skiing-related.

Symptoms and Clinical Presentation

The symptoms of skier’s thumb usually appear soon after the injury but can sometimes take a few hours to fully develop. Common symptoms include:

• Pain at the base of the thumb, especially in the web space between the thumb and index finger.
  
• Swelling and bruising around the thumb joint.
  
• Tenderness to touch on the ulnar side of the MCP joint.
  
• Weakness or inability to grip or pinch objects firmly.
  
• A feeling of instability or looseness in the thumb.
  
• Pain that worsens with thumb movement.
  
• Sometimes referred pain in the wrist.
  
  

If a Stener lesion occurs, a small lump may be felt near the base of the thumb. This occurs when the torn ligament is trapped by the adductor aponeurosis. Early diagnosis and treatment are vital to prevent long-term issues.

Diagnosis

Diagnosing skier’s thumb starts with a clinical examination. The doctor will look for swelling, bruising, and deformity. Palpation helps locate tenderness on the inner side of the thumb. Stress tests are performed by gently bending the thumb MCP joint while comparing the injured thumb to the healthy one. This helps detect ligament laxity or instability.

Sometimes, local anaesthetic may be injected to reduce pain and muscle tension, making the stress test more accurate. Imaging is also important. X-rays rule out fractures or bone fragments that may be attached to the ligament. Ultrasound is a quick, affordable way to view the ligament and check for Stener lesions. MRI scans provide detailed images, especially useful for chronic injuries or unclear cases. Arthrography, which involves injecting contrast material into the joint, is another method to detect ligament tears.

Treatment Options

Treatment depends on the severity of the ligament injury. Partial tears or strains may heal well with non-surgical methods. Complete tears or injuries complicated by displaced bone fragments often require surgery.

Conservative treatment typically involves:

• Immobilising the thumb in a spica cast or splint for 4 to 6 weeks.
  
• Keeping the MCP joint slightly flexed and deviated to help the ligament heal.
  
• Avoiding movement of the thumb during immobilisation to prevent further damage.
  
• Starting gentle range-of-motion exercises after immobilisation.
  
• Gradually progressing to strengthening exercises under professional guidance.
  
  

Surgical treatment is recommended when:

• The UCL is completely torn and displaced.
  
• A Stener lesion is present.
  
• There are displaced avulsion fractures.
  
• The thumb MCP joint is unstable.
  
  

Post-surgery care usually involves immobilisation for around 6 weeks, followed by physical therapy to restore strength and motion. Most patients can return to sports and daily activities within 3 to 4 months after surgery.

Recommended Supportive Products for Skier’s Thumb

For effective management of Skier’s Thumb, proper immobilisation is essential to promote ligament healing and prevent further damage. VibrantFit offers clinically designed products such as the Thumb Spica Splint and the Wrist Brace with Thumb Support, which provide targeted stability to the ulnar collateral ligament and surrounding tissues. These orthopaedic supports ensure optimal immobilisation and comfort, facilitating recovery while allowing necessary mobility. Incorporating these devices into treatment protocols can improve healing outcomes and reduce recovery time.

Complications

If skier’s thumb is left untreated or treated improperly, it can lead to complications such as:

• Chronic instability of the thumb MCP joint.
  
• Weakness in pinching and gripping.
  
• Development of arthritis in the thumb joint.
  
• Persistent pain and limited function.
  
• Stener lesion that prevents ligament healing, requiring surgery.
  
  

Early diagnosis and appropriate treatment reduce the risk of these complications significantly.

Prevention

Preventing skier’s thumb involves adopting safe practices while skiing and during other activities that stress the thumb. Tips include:

• Using proper pole technique to avoid deep pole plants.
  
• Choosing poles with smaller baskets to reduce thumb entrapment.
  
• Wearing protective gloves designed to limit extreme thumb movement.
  
• Learning how to release ski poles safely during a fall.
  
• Strengthening hand and thumb muscles through exercises.
  
  

These measures can reduce the risk but cannot eliminate it completely.

Wrist Supports and Rehabilitation Aids

During recovery, wrist and thumb supports play a key role. These braces immobilise the thumb and wrist, protecting the healing ligament from further injury. They help reduce pain and swelling while allowing some freedom for controlled movement.

Various types of splints and braces are available, including thermoplastic splints, removable thumb spica orthoses, and rigid casts. Working closely with a therapist to use these supports correctly maximises healing and helps regain function faster.

Also read : What is De Quervain's Syndrome

When to See a Doctor

It is important to seek medical attention promptly if you experience:

• Severe pain or swelling at the base of the thumb.
  
• Inability to grip or pinch objects.
  
• Noticeable instability or looseness in the thumb.
  
• Bruising or deformity after a fall or trauma.
  
  

Early diagnosis leads to better outcomes and prevents long-term disability.

Summary and Prognosis

Skier’s thumb is a common but serious injury to the thumb’s ulnar collateral ligament. Prompt treatment, whether conservative or surgical, usually results in a good recovery. Most people regain full function and strength with proper care. Ignoring the injury or delaying treatment increases the risk of chronic instability, weakness, and arthritis. Protecting the thumb during high-risk activities and recognising symptoms early are key to avoiding lasting problems.