On a day like today, skiing may be the last thing on your mind. But I wanted to discuss an injury that can be easily missed for being a lot less obvious than a broken bone, but not any less important and perhaps more difficult to manage.
‘Skier’s thumb’ is an acute injury to one of the stabilizing ligaments to the thumb (ulnar collateral ligament). Tearing of this structure causes thumb instability (a wobbly feeling), persistent pain, inability to grip objects, swelling and deformity in the thumb joint.
A stable thumb is very important for pinch-and-grasp activities. Ligaments in the thumb are soft tissue structures that connect two bones to make a stable joint. A thumb sprain is a micro-tear within the ligaments. The thumb is sore, but stable in this case. In case of a complete tear the thumb will start feeling ‘wobbly’.
This condition started to be recognized as an occupational hazard in European gamekeepers in late 1800’s, and was first accurately described by Campbell in 1955. By repetitively wringing the necks of game (e.g., rabbits) between their thumb and index finger, these workers produced a chronic stretching of the stabilizing ligament to the thumb. The condition became known as gamekeeper's thumb.
How is this relevant in the modern world? Gamekeeper’s modern counterpart is known as “skier’s thumb”.
An acute injury to the base of the thumb as result of thumb getting pulled backward or to the side, skier's thumb got its name because this injury frequently happens during skiing accidents. A person falls, but doesn't let go of the ski pole—pulling the thumb away from the index finger, stretching or even completely tearing the ulnar collateral ligament.
Skier's thumb is the most common upper extremity injury in skiing and is second only to medial collateral ligament (MCL) injury of the knee. Reported injury rates in downhill skiing vary between 2.3 and 4.4 per 1000 skiing days. Of these, between 7% and 9.5% are injuries to the ulnar collateral ligaments of the thumb.
Any athlete who uses their hands is prone to this injury. It is especially common in contact athletes who play football, rugby, and wrestling and have to apply force with their thumb while tackling or grappling.
The diagnosis of an acute injury to the ligament of the thumb is diagnosed during an examination by a hand and upper extremity surgeon. X-rays will determine whether there is a combination of a broken bone, ligament injury or an isolated injury to either structure.
Injuries to the stabilizing ligaments to the thumb are treated conservatively if there is a partial tear or a sprain (micro tear). If a complete tear (Skier’s thumb) is found on a clinical exam surgery is usually required.
The best outcomes for skier’s thumb are in cases where the injury is diagnosed early. The more time goes by the more difficult the repair of the stabling ligament becomes.
In my next blog I will discuss the difference between treatments of acute vs. chronic injuries to the stabling ligaments of the thumb in more detail.
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