Skier’s thumb : My Thumb Hurts after Skiing — Should I see the Doctor?

What is Skier’s Thumb:

Skier’s thumb is defined as an injury to the ulnar collateral ligament (UCL) of the thumb at the Metacarpophalangeal joint (MCP). This injury is usually acute in nature.

As the name suggests, skier’s thumb commonly occurs in skiers. Additionally, it is also a common injury in many athletic sports. UCL is injured when a person falls with an outstretched (extended) hand (arm) to try to block a fall. This valgus forced abduction or hyperextension of the proximal phalanx of the thumb due to a fall causes a partial or complete tear of the ulnar collateral ligament of the thumb.

The research shows that fall is a common culprit (approximately 50%) for the UCL tear. Out of the other 50%, skiing only causes 2 to 3 % of tears. Thus, it is crucial to avoid any fall hazards from the environment and keep up the good balance. It is even true to a geriatric population who already have a compromised balance.

Anatomy for Skier’s Thumb:

The thumb is stabilized by few ligaments as well as muscles. The two main ligaments supporting the MCP joint of the thumb are Ulnar Collateral ligament (UCL) and Radial Collateral Ligament (RCL). In skier’s thumb, a person faces injury of UCL and so any activities with UCL involvement is more difficult and painful.

The main muscles around the thumb are:

• Extensor Pollicis Longus
• Flexor Pollicis Longus
• Extensor Pollicis Brevis
• Flexor Pollicis Brevis
• Adductor Pollicis

These muscles help perform thumb perform flexion, extension, abduction, adduction as well as opposition.

Signs and Symptoms of Skier’s Thumb:

The clinical presentation depends on the severity of the injury as well as the age of the injury (acute vs chronic). The characteristic signs are:

• Pain
• Swelling
• Ecchymosis around small muscles of the thumb (thenar muscles)
• Loose MCP joint or instability of the MCP joint on examination.
• Inability to perform grasp (mainly pinch grasp).
• Any fine motor activities involving the thumb

Treatment Interventions for Skier’s thumb :

The treatment interventions depend on the severity of the injury. A physician will prescribe medicines to address pain, swelling, inflammation as well as to prevent infection if appropriate.

For a partial tear, a physician may recommend a thumb spica splint or a modified wrist splint. Immobilizing the thumb to allow the ligament to heal is the best treatment approach.

Here are a few examples of these splints.

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In case of a complete tear or with a Stener lesion (adductor pollicis muscle get interposed between the MCP joint and the torn ligament) a physician will perform surgery.

Physical Therapy for Skier’s thumb:

Physical therapy is advised on the immobilizer is removed in a partial tear. In case of a complete tear, a gradual exercise is advised for wrist and other digits. Based on the healing, thumb exercises can be initiated 4 to 6 weeks after surgery.

Thumb Active Range of motion:

Thumb flexion and abduction are crucial movements in the skier’s thumb. It is important to note that a patient may not be able to perform a full active range of motion. This holds true, especially after the surgery. So one may have to start with an active-assisted or even passive range of motion. A physical therapist can educate family members to perform a range of motion exercises at home. As the pain subsides and muscle strength improves, a person can perform an active range of motion.

It is also important to note that all range of motion exercises should be done in a pain-free range. Initially, a patient may not be able to tolerate a full range of motion due to pain. Overdoing or overstretching the newly injured muscles or ligaments can make the injury worse. Therefore, always perform a range of motion exercises in a pain-free range.

Below are pictures showing thumb exercises.

Thumb Flexion:

Thumb strengthening exercises:

Once a person is able to perform an active range of motion without any symptoms, one can move to the strengthening exercises. Below are some examples of strengthing exercises for the thumb.

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Grasp strengthening exercise:

Pinch grasp is crucial after a tear of UCL what happens in the skier’s thumb. The exercises shown below are very important to perform.

Please note that different colors of thera bands or thera putties have different resistance. so make sure you consult with a PT prior to changing the color.

Exercises are important to gain a full range of motion. Therefore, gradual practice and proper strengthening exercises will help a person to be able to perform pain-free daily activities.

And at the last, below is a printable PDF for exercises.