Skier’s Thumb is both a common and frequently misunderstood injury. Today, we’d like to shed some light on this condition, including its structures, its symptoms, and the treatment strategies we employ to get you back on the slopes or engaged in other daily activities.
What is Skier’s Thumb?
Skier’s Thumb, medically known as an ulnar collateral ligament (UCL) injury, occurs at the base of the thumb. The ulnar collateral ligament, located on the inner side of the thumb’s metacarpophalangeal (MCP) joint, is crucial in stabilizing the thumb when pinching or gripping objects.
This injury typically occurs when the thumb is forcefully hyperextended or pulled away from the hand—an incident often associated with gripping a ski pole during a fall. Although it’s named for skiers, this injury can happen during any activity where the thumb is subjected to sudden stress.
Structures Involved
The primary structure involved in Skier’s Thumb is the ulnar collateral ligament (UCL) of the thumb’s MCP joint. Sometimes, the ligament may completely tear or avulse (pull away) from the bone.
Additional structures that can be affected include:
- Adductor aponeurosis: This tissue can become interposed between the ligament and the bone, complicating healing (a condition known as Stener lesion).
- Thumb MCP joint capsule: May sustain damage due to the force of the injury.
- Surrounding muscles and tendons: These can be strained or injured as they attempt to stabilize the thumb during a traumatic event.
Symptoms
Patients with Skier’s Thumb often report:
- Pain and swelling at the base of the thumb.
- Difficulty gripping or pinching.
- Instability in the thumb, particularly during lateral movements.
- Bruising around the MCP joint.
Diagnosis
A physical examination is typically the first step. Your doctor or physical therapist will assess thumb stability and look for signs of ligament laxity. Imaging, such as X-rays, may be used to rule out fractures, while an MRI can confirm the extent of ligament damage or the presence of a Stener lesion.
Treatment Options
Treatment for Skier’s Thumb depends on the severity of the injury. It generally falls into two categories: non-surgical and surgical.
Non-Surgical Treatment
- Immobilization: Mild to moderate injuries often require a thumb splint or cast to immobilize the joint and allow the ligament to heal.
- Pain management: Ice and over-the-counter anti-inflammatory medications can help manage pain and swelling.
- Physical therapy: Once immobilization ends, therapy focuses on restoring range of motion, strength, and stability to the thumb.
Surgical Treatment
Severe injuries, including complete ligament tears or those with a Stener lesion, may require surgical repair. Post-surgical physical therapy is essential for optimal recovery, addressing both mobility and strength deficits.
Rehabilitation & Recovery
Rehabilitation is a critical component of recovery. A physical therapy program for Skier’s Thumb typically includes:
- Range of motion exercises: Gradual introduction of movements to prevent stiffness.
- Strengthening exercises: Targeting the muscles around the thumb to restore function and grip strength.
- Functional training: Simulating daily activities or sports-specific tasks to prepare the thumb for return to everyday use.
Most patients recover fully within 6-12 weeks, though this timeline can vary based on the injury’s severity and adherence to the rehabilitation program.
Preventing Skier’s Thumb
To minimize the risk of Skier’s Thumb, skiers should use poles with a proper grip and avoid looping straps tightly around their hands. Maintaining good strength and flexibility in the hands and forearms can also provide extra protection.
Final Thoughts
Skier’s Thumb is a treatable injury, but prompt and appropriate care is essential to prevent long-term complications like chronic instability or arthritis. If you suspect you’ve injured your thumb, don’t hesitate to seek professional evaluation.
As physical therapists, our goal is to guide you through recovery and ensure you regain full functionality so you can return to the activities you love. Schedule a session with a NYC physical therapist today and get back to the slopes with ease!
