Skier's Thumb Q&A

Mr Simon Wimsey is one of our top Consultant Orthopaedic Surgeons at BMI The Cavell Hospital and Nicola Goldsmith is the Upper Limb Services Manager at BMI Healthcare.

Here we ask them about the commonly known skier's thumb injury and how it is treated. Find out more about Hand and Upper Limb Services.

Nicola Goldsmith
Upper Limb Services Manager

  • BMI Healthcare

It is an acute injury to the ligament at the base of the thumb, more specifically the ulnar collateral ligament of the metacarpophalangeal joint. This ligament is vital to the stability of the thumb in function. As the name suggests it can occur skiing but in fact in this country occurs more commonly in people playing rugby or other contact sports, or simply falling on an outstretched hand.

Skiers’ thumb represents 5 - 10% of all skiing injuries, but skiing actually only accounts for 3% of acute ulnar collateral ligament injuries.

Obviously avoiding activities which predispose to these injuries can help. Warming up properly can help reduce the risk of these types of injuries from occurring. Also, when skiing, make sure you do not wrap the ski pole strap around your thumb so if the pole gets stuck in a divot, the thumb does not get pulled backwards! Just let the pole go! However, as almost 50% of skier’s thumbs occur after a simple fall, prevention could prove difficult.

If you hurt your thumb in a fall and the pain and instability persist, you should suspect that you might have sustained this injury. Clinical examination of the thumb by a medical practitioner would look at swelling, bruising, pain and instability during function. Prompt referral to a hand surgeon is important to ensure an optimum outcome. Get yourself a referral for peace of mind.

Many British skiers sustain this injury on the slopes of Europe, assume it is “just a sprain” and ignore it. It is common for these people to present for treatment quite late. The sooner you seek help, the quicker and easier the resolution. Most skier’s thumbs are partial ligament injuries which can be treated by immobilising the base of the thumb for six weeks using individually fabricated casts or splints. If the injury is a complete injury (a full rupture of the ligament) then these commonly require surgery particularly if there is a Stener lesion (interposition of adductor aponeurosis). This is where a muscle attachment gets trapped in the gap and prevents healing. In some injuries a bony fragment is pulled off the thumb base and if displaced these require surgical fixation.

Both conservative and surgical methods have good long term outcomes for patients, but the most important aspect of care is determining what treatment is required. Patients can expect to regain 80 to 90% range of motion, and pinch grip returns to 90 to 95%. Complications are rare, but following surgery some numbness around the scar and dorsum of the thumb can occur, which is usually temporary.

After treatment, stay in the splint for as long as has been advised by your doctor. You should also diligently follow your hand therapists’ advice to minimise the risk of long-term stiffness which, surprisingly, is more common than instability.

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