Skier’s thumb is a common injury affecting the ulnar collateral ligament (UCL) at the base of the thumb, specifically at the metacarpophalangeal (MCP) joint. This ligament acts as a stabilizer, particularly against forces that push the thumb away from the hand, which is crucial for gripping and pinching actions. The injury often occurs when the thumb is forcefully hyperextended or pushed outward, most famously when a skier falls while holding a ski pole, forcing the pole against the thumb. Timely and correct treatment is important because an untreated UCL tear can lead to chronic instability and long-term functional problems with the hand.
Recognizing Symptoms and Administering Immediate First Aid
Individuals with Skier’s thumb typically experience pain and tenderness localized to the inside of the thumb, near the joint where it meets the palm. Swelling around the thumb joint is another common sign, which may also be accompanied by bruising or discoloration in the area. Depending on the severity of the tear, patients may notice weakness in their grip or pinch, or a feeling of instability, as if the joint is loose or “giving way”.
If an injury is suspected, immediate self-care should follow the RICE protocol: Rest, Ice, Compression, and Elevation. Resting the hand and avoiding any movement that causes pain is the first step, as continued activity risks further damage to the ligament. Applying ice to the injured area for about 20 minutes several times a day can help minimize swelling and acute pain, but the ice should never be placed directly onto the skin.
Compression, using an elasticized bandage or wrap, can also help to control swelling, while elevating the hand above the level of the heart aids in decreasing fluid accumulation in the joint. It is important to seek professional medical evaluation promptly after these first-aid steps, as an accurate diagnosis is needed to determine the extent of the ligament damage.
Non-Surgical Management Strategies
The diagnosis involves a physical examination, where a doctor will test the thumb’s stability, often with a stress test to check for joint laxity. Imaging begins with X-rays to rule out a fracture, especially an avulsion fracture where the ligament pulls a small bone fragment away from the joint. For a clearer picture of the soft tissue damage, an ultrasound or magnetic resonance imaging (MRI) scan may be used to assess the degree of the tear.
Non-surgical management is typically reserved for sprains and partial tears, classified as Grade I or Grade II injuries, where the joint remains relatively stable. The primary treatment involves immobilizing the thumb using a specialized splint or cast, often a thumb spica cast, to allow the ligament to heal without being stressed. The immobilization period usually lasts for four to six weeks, keeping the thumb’s MCP joint still.
During this period, anti-inflammatory medications like ibuprofen may be recommended to manage pain and swelling. While the goal is to promote healing of the ligament, patients are advised to avoid forceful pinching or gripping activities for up to three months to ensure full recovery.
Indications for Surgical Repair
Surgery becomes the recommended treatment path when the UCL tear is complete, classified as a Grade III injury, or when a specific complication known as a Stener lesion is present. A complete tear results in significant instability of the thumb joint, which cannot be adequately managed with non-surgical methods alone.
The presence of a Stener lesion strongly indicates surgery because the torn end of the ligament becomes displaced and trapped outside of its normal anatomical position by an overlying tissue layer called the adductor aponeurosis. This displacement physically prevents the two ends of the ligament from reconnecting, meaning the ligament cannot heal naturally, even with external immobilization. Surgical intervention is also often necessary if the injury involves a significantly displaced avulsion fracture, where the fragment of bone pulled off is large or out of alignment.
The surgical procedure, typically performed on an outpatient basis, aims to repair the ligament by reattaching it directly to the bone, often using small anchors or sutures. If the injury is chronic or the ligament tissue is compromised, a reconstruction using a tendon graft may be necessary to restore stability. Following the repair, the thumb is placed into a protective cast for a period of four to six weeks to safeguard the surgical site and allow the reattached ligament to heal securely.
Post-Immobilization Rehabilitation
Once the initial immobilization period is complete and the cast or splint is removed, the focus shifts entirely to regaining full function and strength through a structured rehabilitation program. Physical therapy is a necessary part of the recovery process for both non-operative and surgical patients to address stiffness and weakness caused by the weeks of immobilization. The early phase of rehabilitation concentrates on restoring the thumb’s range of motion, using gentle active and passive exercises.
Specific exercises include active range of motion drills, such as moving the thumb away from the palm and across the palm toward the little finger, to restore mobility in the MCP joint. After regaining mobility, the therapy progresses to strengthening exercises, typically around eight weeks post-injury, to stabilize the joint and rebuild muscle strength. These strengthening activities involve graded resistance, such as squeezing a soft rubber ball or using therapy putty to improve grip and pinch strength.
The timeline for safely returning to sports or activities that place stress on the thumb, like skiing, is usually three to four months following the injury or surgery, but this varies based on individual recovery and the surgeon’s guidance. The final phase of rehabilitation ensures maximum function and stability, which is especially important for preventing re-injury.