A ski trip for many is the perfect winter getaway. Although many will come back tired, and maybe a little sore, all in all they have had an amazing trip. However for some, one small incident can dampen or even end a trip, and can even continue to have consequences upon their return home. The most common injury to the upper limb during skiing is Skier’s thumb. This is an injury to the ulnar collateral ligament (UCL) which sits at the metacarpo-phalangeal (MCP) joint, located at the base of the thumb. The UCL is a strong ligament which supports the MCP joint and prevents it from bending too far backwards or out sideways.
Symptoms of Skier’s thumb
Pain at the base of the thumb and into the webbed space between the thumb and the index finger
Swelling and/or bruising of the thumb
Weakness or inability to grip between the thumb and index finger
Pain with movement of the thumb
Tenderness to touch, particularly on the index finger side of the base of the thumb official.
The most common cause of Skier’s thumb in skiing is falling with a hand outstretched over the pole (Figure 1 opposite - mechanism of Skier's thumb injury), or if a pole gets stuck in powder while skiing and forces the thumb backwards.
However “Skier’s thumb” or a UCL injury can also be caused by other sports or activities. In fact, the most common cause of a UCL rupture is a cycling incident where the rider gets thrust forwards, resulting in the thumb being forced backwards, this time by the force of the handlebars. Another common cause is tennis, when the player falls with an outstretched hand whilst still holding the racquet, although this is less frequent as the player usually drops the tennis racquet first.
If you do fall and injure your thumb, the first thing to do is to have the injury assessed by a health professional. Diagnosis of Skier’s thumb involves a discussion regarding the mechanism of injury, followed by a physical examination, which will enable targeted imaging to be ordered, and management to be commenced.
Usually an x-ray will be taken, to determine if any bone has been broken due to the force of the ligament pulling at it’s attachment (Figure 2). An ultrasound and/or MRI may also be used to determine the state of the ligaments around the base of the thumb.
Figure 2: Fracture of the proximal phalanx bone
Depending on the severity of the injury, the patient may be placed in a splint (Figure 3) or brace to protect the thumb. They will also be required to attend physiotherapy to begin rehabilitation. If the injury is severe, either to the tendon, or to the bone, surgery may be required, to encourage the best recovery of the thumb and hand. If so, this will need to be done quickly, to best preserve the bone and ligament. field.
Figure 3: A thumb “spica” splint
Long term consequences
Long term pain, particularly with use of the thumb for activities which involve a pinch grip
Symptomatic instability and weakness of the thumb
Arthritis of the joint at the base of the thumb
The primary aims of physiotherapy rehabilitation following a Skier’s thumb injury is to strengthen the muscles surrounding the thumb, hand and wrist, to enable normal function of the hand. It is also important to improve and maintain the range of movement of the thumb and stability around the affected joint, to enable adequate gripping and general use. Your physiotherapist will also assist with finding alternative ways to do various daily activities involving the hand, particularly in the early stages of rehabilitation. Why not book your appointment with one of our Physiotherapists today.
Although a ski trip may be one of the more taxing sporting holidays, something always lures us back for more. So next time you are considering going skiing, be proactive and take on board the advice given below, so that you can avoid the disappointment of a skiing injury, and spend your time enjoying your well earned break!
How to avoid sustaining a Skier’s thumb?
Use the pole strap correctly, to ensure that it falls lower than the thumb when dropped (Figure 4)
Alternatively, consider using strapless poles, if the skier is happy to discard the poles during a fall
Correct pole technique for powder skiing, including avoidance of pole dragging and deep pole plants
Downsizing pole “baskets” from the standard 10cm diameter to 6.5cm
Pole length should be 5cm shorter than the recommended length when skiing in powder.
Figure 4: Correct use of a ski pole strap
References:
1. “Skier's Thumb.” Skier's Thumb, The British Society for Surgery of the Hand, 2017, www.bssh.ac.uk/patients/conditions/32/skiers_thumb.
2. “Skier's Thumb.” Skier's Thumb, Physiopedia, 2017, www.physio-pedia.com/Skier's_thumb.
3. Mahajan, Mandhkani, and Steven J Rhemrev. “Rupture of the Ulnar Collateral Ligament of the Thumb – a Review.” International Journal of Emergency Medicine, Springer, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3765347/.