Understanding Skier's Thumb: Causes, Symptoms, Prevention, and Effective Treatments
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 2, 2024
Skier's thumb, or Gamekeeper's thumb, is an injury to the ulnar collateral ligament (UCL) of the thumb, often caused by forceful impacts. It frequently affects athletes and individuals in high-risk activities. This condition can severely impact hand function, causing pain and instability.
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What is skier's thumb?
Skier's thumb involves a sprain or tear of the UCL, a ligament that stabilizes the thumb joint. Known as Gamekeeper's thumb due to its historical link to repetitive stress injuries, it can be classified as a partial or complete tear, depending on the extent of the ligament damage.
Causes and risk factors of skier’s thumb
This injury is commonly caused by skiing accidents but can also result from other sports, falls, or chronic thumb stress from repetitive activities.
Signs and symptoms of skier’s thumb
Symptoms include:
Pain at the thumb base
Swelling and bruising
Thumb joint instability
Weak pinch grip
Difficulty with thumb-dependent activities
Diagnosis of skier's thumb
Physical examination techniques To diagnose skier's thumb, a physical examination involves assessing pain, swelling, and thumb joint stability. The examiner will check for tenderness at the base of the thumb and evaluate the range of motion. The thumb's stability is tested through various stress tests to determine ligament damage.
Imaging studies
X-rays: Useful for identifying bone fractures or dislocations but may not show soft tissue injuries.
MRI: Provides detailed images of soft tissues, including the UCL, to confirm the extent of the ligament tear.
Stress tests for ligament integrity Stress tests, such as the valgus stress test, are used to evaluate the integrity of the UCL by applying pressure to the thumb joint to check for abnormal movement or instability.
Treatment options for skier’s thumb
Non-surgical treatments
Immobilization: Using a splint or cast to keep the thumb stable and promote healing.
Pain management: Includes medications like NSAIDs to reduce pain and inflammation.
Gradual return to activities: After the initial healing phase, a gradual return to activities is recommended to avoid re-injury.
Surgical interventions
Indications for surgery: Surgery may be needed for complete tears, persistent instability, or failure of conservative treatments.
Surgical procedures: Common procedures include UCL repair or reconstruction to restore thumb function.
Post-operative care: Involves immobilization, physical therapy, and a structured rehabilitation program to regain strength and mobility.
Physiotherapy for skier's thumb
Role of physiotherapy in recovery
Physiotherapy plays a crucial role in the recovery process for skier's thumb. It helps in restoring thumb function, reducing pain and swelling, and preventing long-term complications. The aim is to strengthen the thumb, improve flexibility, and enhance overall hand function.
Specific techniques and exercises
Manual therapy: Techniques like joint mobilization can help restore movement and reduce stiffness.
Strengthening exercises: Gradual strengthening of the thumb and surrounding muscles helps support the UCL and improve grip strength.
Flexibility exercises: Stretching exercises improve range of motion and reduce stiffness.
Functional training: Activities that simulate daily tasks to improve hand function and coordination.
Stages of rehabilitation
Acute phase: Focuses on reducing pain and swelling through immobilization, ice application, and rest.
Subacute phase: Involves gentle range-of-motion exercises and beginning strengthening exercises as pain decreases.
Recovery phase: Incorporates more advanced strengthening and functional exercises, gradually returning to normal activities.
Maintenance phase: Emphasizes ongoing exercises and activity modifications to prevent re-injury and maintain thumb function.
Expected outcomes
With effective physiotherapy, most individuals experience significant improvement in thumb strength, flexibility, and overall function. The goal is to return to pre-injury activities with minimal discomfort and optimal hand function. Full recovery time can vary but generally ranges from a few weeks to several months, depending on the severity of the injury and adherence to the rehabilitation program.
Prevention strategies for skier's thumb
Proper equipment and technique: Use appropriate protective gear and learn correct techniques to minimize thumb injury risks during sports.
Hand and wrist strengthening exercises: Regular exercises to strengthen the hand and wrist can reduce the risk of injury.
Awareness of fall prevention: Implement strategies to prevent falls, which can lead to thumb injuries.
Recovery and long-term outlook
Typical recovery timeline: Recovery generally ranges from a few weeks to several months, depending on the injury's severity.
Potential long-term effects: Some individuals may experience lingering pain or reduced thumb strength.
Return to sports and activities: Gradual return is advised, following full recovery and professional guidance to avoid re-injury.
When to seek professional help
Signs indicating medical evaluation: Persistent pain, instability, or difficulty with thumb function warrant a medical assessment.
Emergency care vs. scheduled appointments: Seek emergency care for severe injuries with acute symptoms; otherwise, schedule an appointment for a non-urgent evaluation.
Conclusion
In summary, skier's thumb requires prompt and accurate diagnosis, appropriate treatment, and effective rehabilitation. Proper prevention strategies and awareness of recovery timelines are crucial for optimal recovery and long-term thumb function.
References:
Anderson, D (2010), Skier’s Thumb, Journal: Australian Family Physician, Vol. 39, No. 8, Aug 2010: 575-577
Mohseni, M., & Graham, C. (2022). Ulnar Collateral Ligament Injury. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482383/
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.