Skier’s thumb is an acute version of a condition known as gamekeeper’s thumb. The name gamekeepers thumbs make little sense anymore – as very few gamekeepers present with pain in their thumbs from killing pheasants with their bare hands anymore. It is, quite predictably, common in skiers as well as gamekeepers, Scottish fowl hunters, and athletes (particularly sports like baseball and volleyball). It involves damage to the ulnar collateral ligament (UCL for short). This injury is not to be confused with an ulnar collateral ligament strain in the elbow – which is very common amongst baseball players.
Usually, the injury occurs from falling onto an outstretched hand (and this is why it is common amongst skiers). There are a number of symptoms and signs to look out for. These include:
- You might notice instability of the joint in your thumb
- You might notice pain during a pinching motion
- You might notice weakness in a pinching motion
- You might notice bruising around the thumb which can extend down onto the back surface of the hand
How is skier’s thumb diagnosed?
As mentioned before, skiers thumb is an acute tear of the ligament whilst gamekeeper’s thumb is the chronic version of the condition. Usually, a doctor should be able to give you a diagnosis by taking a history of how you got the injury and doing a quick examination. They might order an X-ray of your hand to make sure there isn’t a break in the boner or that there are no “Stener lesions” (these are bits of bone that are stuck in between the muscles of the hand).
How is skier’s thumb treated?
Your doctor will usually be able to help reduce the pain and stabilize the joint to help it heal. They will offer:
- Pain medications like non-steroidal anti-inflammatory drugs (NSAIDs). These reduce inflammation and swelling in the area, which reduces the number of inflammatory molecules that cause pain signals to be sent to the brain.
- If the doctor thinks you have a partial tear of the ulnar collateral ligament, then they might offer you a splint (a kind of cast that keeps your thumb in place) for a number of weeks to help immobilize the ligament whilst it heals
- If you have a complete tear of the ligament then you will normally require an operation to fix the ligament. If small bones have been fractured and broken because of the tear these will need to be reattached. After the surgery, the doctor will immobilize the joint with a splint for between one and two months. When the splint is removed, a programme of rehabilitation will need to be undertaken to regain strength in the hand. This is usually completed over the subsequent three months. The surgery will need to be done by a specialist orthopedic surgeon.
If you leave this injury, it can progress to chronic ligament damage that will cause pain and loss of movement even after a reparative surgery is completed.