Skier’s Thumb

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The thumb is the first of the hand’s five digits, but it is typically not referred to as a finger. The thumb possesses a unique and wide range of motion not shared by the hand’s other digits. Not only does it bend its knuckle, but the tip of the thumb can touch the tips of the fingers! This range of motion assists in the ability to grasp and hold items.

Skier’s thumb occurs when one of the two main ligaments that support the thumb, (the ulnar collateral ligament) is abruptly stretched beyond its limits. It is usually referred to as a “skier’s thumb” because it commonly results when a skier falls with an outstretched hand while holding a ski pole. However, this condition can also occur in other contact sports where the thumb is vulnerable to injuries, such as football, rugby, or lacrosse. Most often, the ligament is strained when the thumb is jammed backward and out to the side, but strains can occur on any side of the thumb. Although a skier’s thumb is typically caused by a single accident, repetitive gripping and twisting motions can create a painful chronic condition.

Causes & Symptoms

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Your thumb gets sprained when a ligament gets injured or stretched beyond its normal range of motion. A skier’s thumb can be caused when you hit your thumb forcefully against a hard surface or bend your thumb too far in one direction. Trying to soften a fall with your outstretched hand and hitting your thumb on the ground is the most common cause of a skier’s thumb.

Additionally, the ulnar collateral ligament (UCL) is the most common ligament involved in a thumb sprain. This ligament is at the base of your thumb near your palm at the metacarpophalangeal joint (MCPJ). It keeps your thumb from bending too far or dislocating.

As already mentioned, a sprained thumb is sometimes called skier’s thumb because you can easily injure your thumb’s UCL if you hit your thumb at high speeds against a skiing pole. It is also sometimes called gamekeeper’s thumb because of how common a chronic UCL sprain is among gamekeepers.

Generally, there are three degrees of thumb sprain severity:

 

First-degree sprain

 

This is a mild injury in which the ligament may be stretched some but is not torn. When a ligament stability test is applied to the injured joint, the joint remains stable and the ligament remains tight. The stretching of the ligament may still cause pain, mild localized swelling, and tenderness directly over the ligament. Movement of the joint may increase the pain and discomfort.

 

Second-degree sprain

 

This is a moderate injury because there is actual damage to the ligament. The ligament is partially torn resulting in a joint that is unstable. This means that the joint may have sideways movement when it should only be able to flex and extend. The joint may also hyper-extend, meaning that the torn ligament may allow the joint to extend beyond its original extended position. An athlete may experience immediate pain and disability of the thumb. The swelling may extend beyond the injured joint and move either down the thumb and / or up into the hand. A partial ligament tear may result in significant pain anytime the athlete tries to move the joint. The challenge is that the thumb is used in most functional activities involving the hand, so functional disability of the thumb may result in significant challenges.

 

Third-degree sprain

 

The most severe type of ligament injury is a complete rupture of the ligament. The ligament may be torn somewhere in the middle of the ligament or may be torn at either the proximal or distal insertion. In some cases, the ligament rupture may also tear off a piece of the bone. This injury may result in deformity, discoloration, swelling, point tenderness, and pain upon movement. Because a fracture may be involved with a third-degree ligament sprain, an person suspected of having this type of injury should be immediately splinted and referred for medical attention.

 

Symptoms of skier’s thumb can vary by intensity – they commonly include:

 

  • Pain and discomfort at the base of the thumb

 

  • Swelling

 

  • Stiffness

 

  • Bruising

 

  • Tenderness of the thumb, even towards the palm of your hand

 

  • If the injured ligament is completely torn, the end of the torn ligament can cause a lump on the thumb

Who Gets Skier's Thumb?

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Certain risk factors for skier’s thumb include:

 

  • Environmental conditions – Slippery or uneven surfaces can make you more prone to injury.

 

  • Fatigue – Tired muscles are less likely to provide good support for your joints. When you are feeling tired, you are also more likely to succumb to forces that could stress a joint.

 

  • Poorly made equipment – Ill-fitting footwear or other sporting equipment can contribute to your risk of a sprain.

 

Skier’s thumb is highly common in skiers and football players. For skiers, this injury is caused when the skier falls and lands on his / her hand and pole tearing the UCL. The mass of the skier’s body combined with his / her velocity transmits a high force through the arm and into the hand during a fall. If the skier lands on his / her hand, specifically on the pole, the force of the fall is often enough to rupture the UCL.

Football and rugby players are also known to sustain this type of injury specifically while tackling an opponent. Furthermore, hockey players can also be at risk for skier’s thumb injury in the same way that skiers are at risk. The hockey stick can become an instrument of injury if the thumb becomes caught behind the stick either during a fall or during a collision with another player.

How Does It Affect You? How Serious Is It?

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One serious complication that can affect your thumb after leaving it untreated due to skier’s thumb is arthritis. Thumb arthritis commonly occurs with aging. Previous trauma or injury to the thumb joint also can cause thumb arthritis.

In a normal joint, cartilage covers the ends of the bones; acting as a cushion and allowing the bones to glide smoothly against each other. With thumb arthritis, the cartilage that covers the ends of the bones deteriorates, and its smooth surface roughens. The bones then rub against each other, resulting in friction and joint damage. The damage to the joint might result in the growth of new bone along the sides of the existing bone (known as bone spurs), which can produce noticeable lumps on your thumb joint.

Recommended Treatment & Rehabilitation

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Throughout a diagnosis of a skier’s thumb, your doctor will most likely want to know how and when your thumb injury occurred and will ask you to describe your symptoms. He / she will then carefully examine your thumb and hand. To help determine if the ulnar collateral ligament is partially or completely torn, your doctor will move your thumb in different positions to test the stability of the MCP joint. If the joint is loose and unstable, it is an indication that the ligament may be completely torn.

X-rays provide images of dense structures, such as bone. Your doctor may order X-rays of your thumb and hand to ensure that you do not have a fracture or any broken bones. Afterward, your doctor may also take an X-ray of your uninjured thumb to compare it to the injured thumb. In addition, A special type of X-ray, called a stress X-ray, may also be ordered. During this test, your doctor will apply tension to your thumb while it is being X-rayed to learn more about the stability of the MCP joint. If the test causes pain, you may be given an injection or a local anesthetic.

For a severe degree of a skier’s thumb, surgery may be required to restore the stability of your thumb joint and help you regain function. Surgery involves reconnecting the ligament to the bone and / or repairing the fracture using a pin, screw, or special bone anchor. After surgery, you may have to wear a short arm cast or a splint for 6-12 weeks to protect the thumb ligament while it heals.

After diagnosis, a physiotherapist may recommend exercises to help you recover. If you have had surgery or your thumb has been in a cast or splint, you may perform these exercises when your therapist says you are ready. Here are some exercises for you to try at home, including the following:

 

Active range of motion

 

With your palm flat on a table or other surface, move your thumb away from your palm as far as you can. Hold this position for 5 seconds and bring it back to the starting position. Next, rest your hand on the table in a handshake position. Move your thumb out to the side away from your palm as far as possible. Hold for 5 seconds, then return to your starting position. Afterward, bring your thumb across your palm toward your little finger. Hold this position for 5 seconds. Finally, return to the starting position, then repeat this exercise 15 times a day.

 

Thumb strengthening

 

Pick up small items such as paper clips or coins using your thumb and each of your other fingers, one at a time. Practice this exercise for 5 minutes a day.

 

Finger spring

 

Place a large rubber band around the outside of your thumb and fingers. Next, open your fingers to stretch the rubber band before repeating 10 times a day.

 

Wrist flexion

 

Hold a can or hammer handle in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Repeat this exercise 2 sets of 15 times a day. For an increased challenge, slowly increase the weight of the can or weight that you are holding.

 

Wrist extension

 

Hold a can or small weight in your hand with your palm facing down. Slowly bend your wrist up then slowly lower the weight down into the starting position. It is recommended to perform 2 sets of 15 a day.

Alternative & Homeopathic Treatment

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If you suspect that you may have skier’s thumb, then home remedies should address the pain and swelling of your thumb. Here are some homeopathic treatment steps you can take to help reduce your pain and swelling:

 

  • Ice application – Apply ice to the thumb for 35 minutes at a time, up to 4 times per day. Do not apply ice directly to your skin. Continue to use ice until the pain has subsided.

 

  • Immobilization – Avoid movement of the thumb as much as possible. The loose application of a wrap or commercially available wrist brace in the neutral position will help immobilize the thumb. This will help lessen your pain.

 

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – Take acetaminophen for pain relief or ibuprofen for anti-inflammatory action. Avoid both of these over-the-counter medications if you experience stomach problems and cannot tolerate them.