February 25, 2021
Skier’s thumb is an injury sustained to the ulnar collateral ligament (UCL) of the thumb. The function of the UCL is to stabilize the thumb and prevent hyperabduction (thumb pointing too far away from the hand). The mechanism of injury consists of a forced hyperextension and hyperabduction force placed on the metacarpophalangeal joint of the thumb (as shown in the picture above). Also referred to as the gamekeeper's thumb, this injury may occur in sports. For example, forced hyperabduction of the thumb following an attempt at a football save by a goalie.
In regards to all injuries at the base of the thumb this injury accounts for 86% of them. It is seen as the second most common ski-related injury but only 10% of UCL injuries occur while skiing. However, 70% of UCL related injuries are not linked to skiing and are related to a fall on the outstretched arm.
There are 3 grades of ligament sprains and this helps determine if surgery is needed. The first two grades are partial tears and usually do not require surgery. A grade 3 injury is a complete tear and requires surgery. If a stener lesion is to occur it prevents the ligament from connecting with the site of insertion, therefore requiring surgery no matter the grade of sprain.
The beginning of treatment consists of 4-6 weeks of a thumb spica splint for rest and immobilization depending on if surgery was performed. A graded exercise programme will be advised by your physiotherapist to restore thumb/hand/wrist range of motion and strength.