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Skier's Thumb

Dr. Nadheer K M (AIIMS)MBBS

February 11, 2020

March 06, 2020

Skier's Thumb
Skier's Thumb

A sprained thumb can be extremely painful. Thumb sprains normally involve the ulnar collateral ligament (UCL) at the base of the thumb. Depending on the type of sprained thumb, recovery can take up to six weeks. Skier's thumb is one of the most common kinds of thumb sprain. It gets its name from the fact that skiers often get this injury - falling with a skiing pole in hand can lead to a rupture in the UCL, the soft tissues that connect the bones of the thumb.

Skier’s thumb is also called gamekeeper’s thumb. The reason: hunters often suffered this injury in the past while twisting the necks of birds and rabbits. While the two terms are used interchangeably, skier’s thumb is often identified as an acute (sudden) injury while gamekeeper’s thumb, which affects the same part of the thumb, develops over time.

Volleyball players or basketball players who handle a ball much larger than their hands are also more prone to this type of injury, which can worsen over time with repeated use of the injured thumb. In some cases, the use of tools such as a wrench or hammers, or even wringing clothes before drying them can result in the outward stretching of the thumb.

People can make a full recovery from this injury with the right treatment methods and resume work or activity in a short span of time.

Skier’s thumb stages

Like most musculoskeletal injuries, skier’s thumb is also graded between 1 and 3 depending on the severity of the injury:

  • Grade 1: A typical sprain where the ligament gets stretched but does not tear, making it a mild injury.
  • Grade 2: Partial tear of the ligament, which requires a prolonged period of recovery and the need to wear a thumb splint.
  • Grade 3: A complete tear of the ligaments that causes severe pain and discomfort, and requires months of recovery and in cases of fractures, surgery.

The thumb pain is least in a grade 1 injury and most in a grade 3 complete ligament tear.

Symptoms of skier’s thumb

The evolutionary advantage of opposable thumbs has allowed us to perform a multitude of tasks with our hands alone, but injuries like skier’s thumb can be severely debilitating, stopping you from carrying out daily tasks as well. Some of the symptoms of skier’s thumb include:

  • Pain: Any acute or overuse injury always presents itself as pain at first. In this case, the pain is usually located at the base of the thumb and around the webbing between the thumb and the index finger.
  • Swelling: There is usually swelling in the thumb as a result of the injury.
  • Tender to touch: The inflammation or swelling of the area also signifies the spot being tender to the touch.
  • Discolouration: There are often bruises at the bottom of the thumb due to the injury.
  • Reduced strength: Inability to grip objects, pinch or hold anything with the help of the affected thumb.
  • Wrist pain: In some cases, patients can experience a referred pain in the wrist as a result of the injury to their thumb.

Causes of skier’s thumb

An injury to the hand in which the thumb is bent or stretched back excessively leads to skier's thumb. A majority of these injuries occur during a fall as your hand stretches out to cushion the fall.

In some cases, car accidents can also lead to such injuries as the hands are wrapped around the steering wheel with the thumb on the opposite side - the hand can twist upon impact.

The wringing motion while drying clothes may also cause this injury.

Tips to prevent skier’s thumb

Most of the causes of skier’s thumb are sports specific, but the preventive measures can be practised by anyone. Here are a few examples:

  • While driving, try to grip the steering wheel without locking your thumbs in the opposite direction. Keeping the thumb on the same side as the fingers would ensure that they are not hyperextended in the event of an accident.
  • Skiing-specific tips including swapping the existing ski poles with resized ones, along with learning to drop the ski-poles before a fall.
  • While operating heavy equipment or machinery, use specially designed gloves that protect the thumb from hyperextending repeatedly.

Diagnosis of skier’s thumb

Skier's thumb is usually caused by an acute injury. The specific location of the injury and what you were doing when you got hurt are important cues for the doctor to diagnose this condition.

Usually, the pain of skier's thumb will be severe - you should consult a doctor as early as possible. While a physician is the first person you can visit, going to the emergency room of a hospital or seeing an orthopaedic or hand specialist is also a good idea. Here's what to expect in the doctor's office:

  • The doctor will first perform a physical exam to check the severity of your pain, swelling and other symptoms if any, along with asking about how the injury occurred.
  • Imaging tests such as an X-ray and MRI scan may be performed to ascertain the exact location of pain, and the extent of damage to the muscle tissues or ligaments. Imaging tests can also reveal if there has been any damage to the bones like in the case of a fractured hand.

Treatment for skier’s thumb

Based on the severity of the injury and subsequent diagnosis, the doctor may recommend the patient to a sports injury specialist or an orthopaedic or hand surgeon, which is followed by a treatment plan:

  • At the time of the injury, the patient is advised to immobilise the thumb joint and restrict movement to bring down the pain.
  • Home-based care includes application of RICE therapy, a combination of rest, ice, compression and elevation to further bring down the pain and swelling in the affected area.
  • Additionally, non-steroidal pain medication such as ibuprofen may be taken to manage the pain and other symptoms.
  • Putting the hand in a specially designed cast or splint that keeps the thumb straight and doesn’t allow it to move around can help it to heal.
  • Partial tears require several weeks of immobilisation, sometimes in a more permanent, lightweight cast.
  • It may be necessary to get several hours of physiotherapy to get the full range of motion back in the thumb joint and resume work - or sports.
  • In case of complete ruptures and tears, the patient may have to undergo surgery to repair the torn ligaments or broken bones.

Read more: Repetitive strain injury: types, symptoms, causes, risk factors, treatment, diagnosis, prevention

Exercises for skier’s thumb

Gentle exercises are recommended after the person has healed, to regain mobility as well as strengthen the affected thumb joint.

1. Thumb IP flexion

The thumb has an interphalangeal (IP) joint that helps us to move the thumb towards the palm (flexion). Skier's thumb injury affects this part of the thumb. Exercising this area after medical treatment can help to strengthen it and regain mobility. Here's how to do it:

  • Fold the fingers of your injured hand into a fist.
  • With the other hand, tightly press the affected thumb against them.
  • Move the affected thumb up and down slowly.

2. Thumb and wrist motions

  • Practice the natural movement of the thumb in all directions slowly to regain the range of movement.
  • Practice the same with the wrist as well, moving it about in all directions without holding anything in your hand.

3. Thumb strengthening

  • You will need a table tennis ball or something small like an eraser for this exercise
  • Try holding the item between your thumb and two fingers of the injured hand.
  • If you used the index and middle finger in the previous step, now try holding the object between the thumb and the middle and ring finger of the injured hand, and so on. 

4. Grip strengthening

  • Practise strengthening your grip with the help of a stress ball without trying to strain your injured thumb.
  • Simply hold a stress ball in your hand and squeeze - adjust the pressure according to what is comfortable for you.

Takeaways for skier’s thumb

A common skiing injury, skier’s thumb doesn’t just affect the people who practice this popular winter sport. Examples of skier’s thumb can be seen during sudden falls or in accidents, especially involving the person driving the car.

Although the degree of damage can vary from mild to severe, the affected hand will not be able to grip or hold things with the resulting pain. Treatment includes immobilising the thumb joint of the affected hand, along with hours of therapy, but people suffering from such injuries are able to make a full recovery.

In some rare cases, however, the severity of the injury can call for surgical intervention to treat the affected joint in order to bring back the stability, movement and weight-bearing strength.



References

  1. Jenkins M et al. Thumb joint flexion. What is normal? Journal of Hand Surgery Br. 1998 Dec;23(6):796-7. PMID: 9888685.
  2. Mahajan M and Rhemrev SJ. Rupture of the ulnar collateral ligament of the thumb - a review. International Journal of Emergency Medicine. 2013 Aug; 6: 31. PMID: 23938194.
  3. The British Society for Surgery of the Hand. [Internet] London, United Kingdom; Skier's thumb
  4. MedlinePlus Medical Encyclopedia [Internet]. US National Library of Medicine. Bethesda. Maryland. USA; Skier's thumb - aftercare
  5. Harding P and McKeag L. Skier's thumb: a literature review. Australian Journal of Physiotherapy. 1995; 41(1): 29-33.
  6. Anderson D. Skier's thumb. Australian family physician. 2010 Aug; 39(8):575-577.

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