Skier's thumb (Gamekeeper's thumb)
What is it?
This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal joint. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead onto to a chronic instability of the thumb which causes problems with function.
The injury happens when you fall onto the outstretched thumb (see diagram)and is more likely if the thumb is gripping something at the same time. Falling when skiing while holding a ski pole is a common cause hence the name frequently given to this injury.
Less often there is no specific injury and the cause is due to a chronic stretching of the ligament. This is referred to as a ‘gamekeeper's thumb’. Patients with this problem complain of a loss of strength when pinching or gripping with the thumb.
What are the symptoms?
The thumb will be swollen, bruised and painful. Treatment consists of either a period of splintage or a repair of the ligament with an operation.
The most important decision in deciding which method of treatment is used is identifying whether the ligament is partly or completely torn and, if it is torn, whether the ligament has displaced into a position where healing may not be possible (This may be referred to by your treating surgeon as a Stener lesion).
Making this decision may be possible with a gentle examination but it can be hard to decide as the thumb is sore and swollen. Other methods can be used to help with assessing the degree of injury. One maybe to inject some local anaesthetic around the thumb and to then examine the joint again. An x-ray may help if there is a fracture of a small fragment of bone which the ligament is attached to. Displacement of this fracture may indicate a complete tear. An ultrasound examination can help.
What is the treatment?
If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is used to get the thumb moving again. It can take several weeks for the movement and the strength to return.
If the ligament is completely torn then an operation to repair the ligament will be performed. This is followed by a similar period of splinting and subsequent exercise programme.
For some patients it is recommended to use a splint to support the thumb after this type of injury when undertaking sport or heavy activity. Your treating surgeon or therapist can advise on this.
What is the outcome?
The outcome from this injury is generally for the ligament to heal and the thumb function to return to normal. Occasionally the ligament does not heal properly and the thumb becomes weaker and unstable. If this is a problem further surgery to reconstruct the ligament or fuse the joint can be done.