Skier’s thumb injuriessrortho
Skier’s thumb is an injury of the soft tissue that connects the bones of the thumb together. This type of injury can happen from falling on an outstretched hand that violently pulls the thumb away from the index finger, stretching or tearing the ulnar collateral ligament (UCL) in the process. This type of injury accounts for about 10 percent of all skiing accidents; when the skier falls without releasing the ski pole.
Repetitive use injuries to the thumb resulting in torn or stretched UCL can happen also as a gradual rubbing away of the UCL due to wear and tear. As a repetitive injury this condition is generally referred to as Gamekeeper’s Thumb – a name coined in 1955 when Scottish gamekeepers (rabbit keepers in particular) were reporting such work-related injuries. Rheumatoid arthritis and nicotine use can also cause damage to the ligaments, making them more susceptible to this type of injury.
Symptoms will vary depending on the severity of the injury to the ligament. Pain ranging from mild to severe may be accompanied by bruising, and edema, caused by excess fluid trapped in the tissues – may also present in the hand. Weakened grip or reduced thumb range of motion are some of the more obvious symptoms. If the ligament has been completely torn there may be a bump at the base of the thumb, and the thumb can then hang loosely at an uncomfortable angle.
When UCL injury is minor, symptoms may be treated non-surgically starting with the use of ice packs over the first few days, which works well to soothe pain and reduce swelling. The thumb may also be immobilized in a cast or splint for the first 3 weeks following injury. Once the splint is removed, hand therapy and strengthening exercises will be recommended by the doctor. Recovery time for minor injuries usually takes about 4 to 6 weeks.
In severe cases that result in complete tearing of the ligament, the injury must then be surgically repaired. Major injury to the UCL will require surgical fixation right away. When surgery is delayed complications are much more likely, and a full return of function is less possible. Surgical repair of the UCL can be performed on an outpatient basis using a minimally invasive approach. During the procedure, the ligament is anchored to the bone using pins or sutures. The thumb is then placed in a cast or splint to protect the repair. Once the site has healed; hand therapy is recommended to help restore full function and range of motion to the thumb.
In many cases, patients who have recovered from skier’s thumb are able to return to work (and skiing) in a relatively short period of time, providing they stick to the rehabilitation protocols. A period of physical therapy is essential to the recovery process, to ensure that the ligament heals correctly.
Highly Skilled Hand and Upper Extremity Surgeons
The Hand Center at SRO, led by Kai-Uwe Mazur, MD and Dominic J. Mintalucci, MD is the only solely focused hand and upper extremity practice in California and Oregon north of San Francisco that consists of two board certified orthopedic hand surgeons who have completed ACGME accredited fellowship training in hand and upper extremity surgery.