Skier's Thumb

A lot of us are eagerly looking outside the window every morning as of mid-November just hoping for that first dusting of snow that signals skiing season is finally close. But as you're packing up your poles and heading off to the slopes, it pays to keep in mind that a great skiing season is one without injury.

While we may hear more about lower body injuries when it comes to skiing, injuries to the thumb are approximated to make up 5 -10% of the total (Foye, 2010), and if not properly managed can have devastating consequences. Skier's thumb occurs when the thumb is forced backwards away from the hand, causing damage to the ulnar collateral ligament that connects the bones at the base of the thumb. The ligament can be fully or partially torn, and sometimes may pull a piece of bone off resulting in a small break known as an avulsion fracture. Simply falling on an outstretched hand can cause this type of injury, but it is much more likely to occur from a fall with a ski pole in the hand, which is why it is strongly correlated with skiing.

Skier's thumb typically presents with pain at the base of the thumb which worsens with any movement, swelling and possibly bruising in the area, difficulty using the thumb to grasp and soreness if you touch along the inner side of the thumb. If you incur some of these symptoms, skip the wait at the doctor's office and book an emergency appointment with a physiotherapist. By asking you specific questions about what happened at the time of injury and by observing the area and performing specific tests, your physio can confirm a diagnosis and help you make a plan for treatment.

If there is any possibility of a break, you will be sent to have X-rays taken. If the physiotherapist suspects that the ligament is fully torn

then you will be advised to see an orthopedic doctor to send you for more testing in the form of an MRI or ultrasound to get an exact picture of the damage. In cases where there is a complicated break or the ligament is fully torn, surgery is essential to repair the lesion. If the ligament is damaged but still attached (a partial rupture), or if there is a small piece of broken bone that has not moved out of place, it can be treated conservatively, that is, without surgery. In these cases you will be immobilized in a brace for around 4 weeks. Your physio will provide treatment to speed up the healing, decrease the pain, help you with your mobility and strength, and finally make sure you are fully recovered before returning to skiing to prevent the injury from recurring. Don't be fooled; the thumb may be a small area but it is essential to have it in top shape for many of your activities, not limited to skiing. Studies have shown that injuries requiring surgery that do not get it may result in permanent disability of the joint (Heim, 1999), so don't risk ignoring your symptoms.

It is great to know what to do in case of an injury, but knowing how to prevent it can save you a lot of trouble. Skiers should be trained to drop their poles before they land from a fall. This simple act will significantly decrease your chance of suffering from skier's thumb. Furthermore, you are safest using poles with finger grooves, without any restraining devices such as a wrist strap.

Finally, if you are returning to sport after a thumb injury, a taping of the joint or a protective brace could mean the difference between hitting the slopes all season long…or being stuck waiting until next year.

Best of luck this season!

Heather Little, physiotherapist, Action Sport Physio West Island

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Sources
Foye, P. Skier's Thumb. eMedicine [online]. Revised Aug 31, 2010. (Cited Dec 8, 2010).

Heim, D. The skier's thumb. Acta Orthopaedica Belgica. Dec 1999; 65(4):440-6.