Skier’s thumb

What is a skier’s thumb?

The colloquial term "skier's thumb" refers to the condition of a torn ligament around the thumb's metacarpophalangeal (MCP) joint. This involves the ulnar collateral ligament, which stabilizes the MCP joint on the side facing the little finger.

This condition is known as skier's thumb because it is a common mechanism of injury when skiing.

The metacarpophalangeal joint of the thumb allows for precise movements of the thumb and enables essential hand functions such as gripping or writing. As skier’s thumb may lead to instability of this joint, treatment is strongly recommended.

How does a thumb collateral ligament rupture occur?

The ulnar collateral ligament of the thumb metacarpophalangeal joint can tear by various injury mechanisms. What these mechanisms have in common is that the thumb is abducted and stretched out, exposing the ligament to significant tension. If the ligament cannot withstand this force, it tears.

The typical mechanisms of injury include falls where one braces strongly with one hand or through skiing accidents. In the latter case, the ski pole plays a significant role, as the strap around the thumb can be pulled forcefully during an accident, leading to a ruptured ligament.

Which symptoms are typical for a collateral ligament rupture?

An ulnar collateral ligament rupture generally causes very specific symptoms. These include pain around the MCP joint of the thumb. There may also be swelling in this area shortly after the accident.

Another important symptom of skier's thumb is the feeling of instability in the thumb. In most cases, this is not noticed until a while later as the joint is initially protected automatically due to the pain. After a bit of time, once patients start to move their thumb again, when writing for example, this instability is noticed.

Left untreated over time, the injury can lead to improper loading of the thumb which can damage the joint cartilage resulting in a wear and tear type of osteoarthritis. This manifests itself with painful restricted movement of the thumb and recurrent inflammatory reactions when there is increased load.

How does a doctor diagnose a skier’s thumb?

To diagnose a skier's thumb, a detailed medical history and physical examination are carried out alongside various imaging procedures.

At the start of the examination, the specialist takes a detailed medical history. Specific details on the injury mechanism are very important, as they can already provide initial indications for this type of injury. Primary physical examinations of the thumb are carried out with great caution.

Following this, an X-ray is usually performed to rule out any bone injuries. Once there are no indications of a fracture, different instability tests of the thumb can be done.

The type and execution of the tests depends on the patient’s pain level and the experience of the doctor. The tests assess the ability to spread the thumb, determining how much further the thumb on the injured side can spread compared to the uninjured side.

The simplest clinical test is to ask the patient to hold a piece of paper between their thumb and index finger. The doctor then pulls on this paper. When the sides are compared, the doctor will typically notice that the patient is not able to hold the sheet of paper on the affected side as well as on the healthy side.

To finally verify the condition, further imaging procedures such as magnetic resonance imaging (MRI) are used. In the case of experienced examiners, an ultrasound examination can be done.

Skier’s thumb treatment: what does conservative therapy involve?

Whether conservative or surgical therapy is appropriate depends on the extent of the condition and the patient’s symptoms.

Conservative therapy is an option when the ligament is not fully ruptured and there is only minimal instability.

This method involves resting the thumb joint. The entire thumb and wrist are immobilized using a splint or a brace for approximately six weeks. Pain medications are given if necessary.

After this period, a stability test of the joint should be done. If stability of the joint is confirmed, then patient may resume normal thumb movements. If symptoms persist, further diagnostic measures may be required.

Skier’s thumb surgery: procedure and duration of the operation

In many cases, conservative therapy is not sufficient to heal skier’s thumb entirely. If there is a complete rupture of the ligament, surgical repair is necessary. Furthermore, another urgent indication for surgery is a Stener lesion.

In the case of a Stener lesion, the torn ulnar collateral ligament becomes trapped under a tendon sheath of the thumb’s musculature. In turn, this trapping prevents the ligament from returning to its original position.

The operation to repair a skier’s thumb should be done within two to three weeks of the injury to avoid the risk of the ligament fragments retracting and becoming impossible to reattach.

The procedure is generally relatively fast and simple and can often be done on an outpatient basis, allowing the patient to return home the same day.

Through a small incision, the surgeon exposes the ligament and finds the exact tear site. Most commonly, the ligament is ruptured directly at its bony attachment, and is therefore reattached using a small bone anchor. These anchors can remain in place and typically do not cause discomfort.

If the ligament has torn along its length, it can be stitched together using traditional methods.

The operation becomes more complex if a small bone fragment has been torn off as well.  Here, the bone fragment must be reattached which is mostly done with the help of small wires. These need to be removed about six weeks following the procedure.

The thumb is immobilized in a splint for approximately five to six weeks after the operation. Physiotherapy may be recommended to prevent stiffness and maintain joint mobility.

Risks and possible long-term consequences

With the right diagnosis and early treatment, a skier's thumb usually heals without complications. The greatest risk for continued pain and movement limitations arises if therapy is not started early enough.

If the torn ligament has already retracted significantly, it can often no longer be sutured. In these cases, a procedure called ligamentoplasty, also known as ligament reconstruction, can be done. Here, the damaged ligament is replaced with a tendon from the forearm, and it is attached to the appropriate bone attachment sites.

If ligamentoplasty is no longer an option, for example because the rupture is too old and has already caused further damage like osteoarthritis, a procedure called joint fusion may be necessary. However, this should be considered only as a last resort after all other options have been explored.

It is important to note generally that permanent movement restrictions may occur, especially after surgical treatment. The primary goal is to maintain the stability of the joint, so this limitation is often an acceptable trade-off.

What is the function of a thumb brace?

Braces have the function of stabilizing a joint within specific limits. Movement can either be completely prevented or made possible up to a certain extent. The choice depends on the symptoms in question.

When treating skier's thumb, braces usually cover all of the thumb’s joints, completely restricting movement.

The advantage of a brace is that it is light and easy to use. It can often be individually tailored to the patient. An advantage of the brace is that when strict immobilization is no longer needed, it can easily be removed and put on again. In this way, it differs greatly from a classic plaster or plastic splint.

Which doctors and clinics specialize in skier’s thumb?

Skier’s thumb is a condition that can have unpleasant consequences if treatment is not sufficient or not provided. It should therefore be diagnosed and treated by experienced hand surgeons.

We have made it our goal to connect patients with the most suitable specialists for their specific medical conditions. Therefore, we have carefully reviewed and selected the specialists listed here based on their extensive experience in treating skier's thumb.

Discover the expertise we offer and schedule your first appointment with one of our specialists quickly and easily.