Skier's Thumb

 
Lindsey Vonn, U.S. Ski Team Olympic Gold Medalist

History and Overview

Skier's thumb: an injury of the ligament that connects the bones of your thumb together.

This injury was originally noted in 1955 as a chronic ligament problem seen in Scottish gamekeepers who damaged their thumbs by repeatedly twisting the necks of hares. The injury was termed “the gamekeeper's thumb.”

Due to the popularity of downhill skiing, the injury has become much more common in the US.  Therefore, it is now referred to as “skier’s thumb.”

Occasionally, a complete tear of the ligament occurs and must be surgically repaired. The ultimate stability of the ligament is important because of its contribution to the grasping function of the thumb.

People with skier’s thumb may be able to return to work and even skiing in a short period of time with proper rehabilitation.

Causes

• Falling on an outstretched hand with a ski pole in the palm of your hand
  • Creates the force necessary to stress the thumb and stretch or tear the ligament
  • A simple fall on an outstretched hand with an empty palm usually does not create this same force
  • Your thumb can be injured if it jams into packed snow at high velocity

     

• An automobile crash in which the driver has the thumb alone draped over the steering wheel

   

• Any injury in which the thumb is abnormally bent backward or to the side

 
Signs and Symptoms

The two most important symptoms to look for:

• Inability to grasp or weakness of grasp between your thumb and index finger
• Tenderness to the touch along the index finger side of your thumb

  
  You may also notice:

• Pain at the base of the thumb, in the web space between thumb and index finger
• Swelling of your thumb
• Blue or black discoloration of the skin over the thumb
• Thumb pain that worsens with movement in any or all directions
• Pain in the wrist (which may be referred pain from your thumb)
• Unstable joint

Symptoms may occur minutes to hours after the injury.

Evaluation

• A test to see how many degrees the thumb will move
  • Measures the laxity of the ulnar collateral ligament of your thumb
  • Movement will be compared to the uninjured thumb
  • If pain makes this difficult to do immediately, the injury may be treated and then reexamined in a few days
• Assessing the normal functioning of the three major nerves in your hand
• Checking for point tenderness over certain bony spots of your hand that may indicate fracture
• X-ray of your hand to make sure no bones are broken
  • X-rays sometimes show a small fragment of the metacarpal has been pulled off by the ligament called avulsion fracture
• Examining the arm for any associated injuries to your wrist, forearm, elbow, and shoulder

 
At-home Treatments

• 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 stops

     

• Avoid movement of the thumb as much as possible
  • Loose application of an ACE wrap or commercially-available wrist brace in the neutral position will help immobilize the thumb
  • This will help lessen your pain

     

• Take acetaminophen for pain relief or ibuprofen for anti-inflammatory action
  • Avoid both of these over-the-counter drugs if you have stomach problems or cannot tolerate them

     

• The most important aspect of home care is to ensure that the injury is fully evaluated by a certified athletic trainer, emergency doctor, orthopedic surgeon or your primary care physician in the first few days!

Medical Treatment

• A partial tear will likely be treated with immobilization for several weeks.
• A complete tear will usually require surgical repair

 
Prevention

• Skiers should be taught to consciously discard the ski pole during all falls. Falling onto an outstretched hand while skiing without the ski pole in hand should minimize the chance of injury.

   

• Skiers should also be encouraged to use poles with finger-groove grips without any restraining devices such as a wrist strap or closed grip.

   

• You can prevent skier's thumb during a motor vehicle accident by keeping your thumbs on the outside of the steering wheel along with your fingers. This new routine will require a conscious effort because most drivers are taught to grip the steering wheel in a fashion similar to a ski pole.

Exercises

• Thumb range of motion - Move your thumb in all planes.Hold it at the point furthest from the hand for a few seconds, then move back.

   

• Wrist range of motion – Move your wrist in all planes: flexion, extension, and radial/ulnar deviation (side to side). Hold for a few seconds in each direction.

   

• Grip Strength – Squeeze an object such as a tennis ball. Hold squeeze for 5-10 seconds. Do 3 sets of 10 a few times per day.

   

• Thumb Strengthening – Pick up objects such as marbles or paper clips with your thumb and each finger separately.