Orthopedic Surgery News Archive Featured in the Media JeffNEWS

Most likely you’ve never heard of the term “skier’s thumb” -- unless you’re one of the unlucky snow bunnies, weekend warriors or highly trained athletes to have experienced its severe symptoms ‘first hand.’  But orthopaedic specialists at Thomas Jefferson University Hospital say it's important to be aware of this acute injury before hitting the slopes so you don't end up with chronic pain and dysfunction.

“This is an injury we often see when a skier has fallen with his or her hand caught in their ski pole, causing the thumb to be stretched or pulled away from the body,” said Charles Leinberry, Jr., M.D., hand and wrist specialist at the Rothman Institute at Thomas Jefferson University Hospital, and assistant clinical professor of Orthopaedic Surgery at Jefferson Medical College in Philadelphia.  “It’s due to the levering action of a ski pole that the thumb tends to get caught, which places a significant amount of stress on the ulnar collateral ligament.”

The ulnar collateral ligament is a band of tough, fibrous tissue that connects the bones at the base of the thumb where it joins the hand.  This ligament prevents the thumb from pointing too far away from the hand.  If the ligament is pulled far enough it will stretch and eventually tear.  While there are many ways to injure the ulnar collateral ligament, says Dr. Leinberry, “skier’s thumb” is the most common designation for an acute injury to it.  It may also be referred to as “gamekeeper’s thumb.” (The name stems from a grasping, work related injury associated with European gamekeepers.)

Symptoms of “skier’s thumb” include pain and swelling directly over the stretched or torn ligament at the base of the thumb.  Patients often have difficulty grasping objects or holding them firmly in their grip, as well as pain with these activities.  They may also complain of instability or difficulty holding their thumbs in their pants’ pockets.

Treatment depends on various factors including the extent of the injury and how long ago it occurred, as well as the age and physical demands of the individual.  Typically, if the tear is incomplete and the thumb is not too loose, the patient is placed in a cast or a spica splint for four to six weeks and non steroidal anti-inflammatory drugs may be used to decrease pain and swelling.  After this, range of motion exercises can help regain flexibility and strength.  Surgery, which is most effective within the first few weeks to months of the injury, may be an option if the ligament is completely torn or the thumb is particularly unstable.  Radiological imaging such as X-ray and an MRI can help the patient’s physician decide between operative and non operative care.

For older injuries, one option is to use local tissue to reconstruct the ligament.  If arthritis has already started to develop, then fusion may be the only option.

“Skiing and other sports have great physical and mental benefits,” said Dr. Leinberry.  “We just need to remember a few simple steps to protect ourselves when we head out to the slopes:”

1. Know your limits–don’t attempt things over your head.
2. Make sure that your equipment is in good working order (skis are sharp and bindings have been checked).
3. Maintain physical fitness to be ready for the demands on your body.
4. If you feel yourself falling try to relax and fall to your side, letting go of your poles to prevent thumbs from getting caught in the levering action.
5. Ski under control. 

What to do if you are injured?

1. Seek medical attention–there are always first aid (ski patrol) stations at every ski area. 2. Once back home seek qualified orthopedic hand surgeons to further evaluate and treat your injuries.

What happens if you let an injury to this ligament go too long without proper medical attention?  

You are gambling with your hand – a body part you need and use all day, every day.  Sometimes the injury will heal on its own.  However, if the ligament is completely torn and no treatment is received, an individual is at a very high risk for developing arthritis.