Skier’s thumb, also known as “gamekeeper’s thumb,” is an injury to the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal (MCP) joint. It involves a sprain, partial tear, or complete tear of this ligament.

Common Symptoms

• Pain at the base of the thumb, particularly on the inner side
• Swelling and inflammation around the thumb joint
• Bruising or discoloration of the skin
• Weakness or instability in gripping objects
• Tenderness to touch at the torn ligament site
• Worsening pain with thumb movement and difficulty pinching.

Cause & Anatomy

The most common cause is a fall on an outstretched hand while holding something, such as a ski pole, causing hyperabduction and hyperextension forces on the MCP joint, leading to a UCL tear. It can also occur in other sports or activities that involve similar forces on the thumb. A bicycle handlebar can catch the thumb in a fall. Anything that pulls the thumb away from the thumb may cause the tear.

The ulnar collateral ligament (UCL) is a key stabilizing ligament on the inner side of the thumb’s MCP joint. It prevents excessive abduction (sideways movement) of the thumb and is crucial for grasping and pinching functions.

Diagnosis

• Physical examination to assess ligament laxity and instability
• X-ray to rule out fractures
• Ultrasound or MRI may be ordered to evaluate the extent of UCL injury

Prevention

• Discard ski poles during falls to avoid the outstretched hand position. Avoid putting your hand and thumb through the strap on the ski pole.
• Use ski poles with finger-groove grips instead of wrist straps for easier release

Treatment

• Grade I and II (partial tears): Immobilization with a cast or splint for 4-6 weeks, along with anti-inflammatory medications and ice
• Grade III (complete tear): Surgery may be required to repair or reconstruct the torn ligament

Surgery

For complete UCL tears, surgery involves repairing or reconstructing the damaged ligament using sutures, anchors or grafts.

Rehabilitation

After surgery or immobilization, a structured rehabilitation program supervised rehabilitation by your surgeon and therapist is crucial. It includes progressive exercises, manual therapy, and functional activities to regain strength, flexibility, and function in the thumb.

FAQ’s

Can skier’s thumb occur in non-skiers?
Yes, this injury can occur in any activity that involves similar forces on the thumb, such as rugby, handball, basketball, volleyball, soccer, or anything that tears the thumb away from the hand.

How long does it take to recover from skier’s thumb?
Recovery time varies depending on the severity of the injury and whether surgery was required. Partial tears may heal within 4-6 weeks of immobilization, while complete tears requiring surgery may take 4-12 weeks of rehabilitation after the procedure. The swelling lasts for many months.

Can skier’s thumb lead to chronic problems?
In some cases, even after proper treatment, chronic pain, instability, or loss of range of motion in the thumb joint may persist, especially with complete UCL tears.

Is skier’s thumb a common skiing injury?
Yes, skier’s thumb accounts for 8-10% of all skiing injuries, making it a relatively common occurrence among skiers.

Is this a jammed thumb?
Some jammed thumbs get better but many are more severe injuries with long term consequences. They can be similar in how they appear. A correct diagnosis, the right splint, and the right timing for mobility are crucial for success. See your orthopedic surgeon to make certain it does well.