Skier's thumb

The thumb is an important digit, but it can be vulnerable to injury by virtue of its isolation from the fingers of the hand. The thumb can be 'pulled back' or 'bent back' very easily, which can lead to injuries of the small ligaments and structures which bind the thumb bones together.

One such injury occurs frequently. Originally known as a 'Gamekeeper's thumb' (as a reference to the chronic stretching and tearing of the ligament caused by forceful gripping and twisting of rabbit's necks by gamekeepers in the Scottish Highlands), but now more commonly referred to as a 'Skier's thumb', injury to the ulnar collateral ligament occurs after forceful bending back (hyperextension) of the thumb. The 'Skier's thumb' is an acute injury caused by an instantaneous tearing of this ligament when the thumb is caught either in the ski pole or on the surface of matting when skiing on a dry slope.

There is often little to see on immediate inspection, but the thumb will be very painful on the inside, and gripping (particularly pinching) will be painful and weak.

The pain settles but, without treatment, leaves a permanently weakened thumb and deficient pinch grip.

Early identification of the injury will allow surgical reattachment of the torn ligament - back to where it was ripped off the bone - and functional recovery will be excellent. A delay in diagnosis beyond 2 or 3 weeks will mean that a direct repair is rarely possible, and a new ligament will need to be reconstructed from a spare piece of tendon. This is a much more complicated operation, which leaves the thumb stiffer and less mobile than after an early repair, so all attempts should be made to get assessment and, if necessary, treatment at an early stage.

After surgery, the healing tissues will need to be protected in a plaster cast, or a specially made plastic splint, for 6 weeks. A return to all previous activities can then be expected. Splints can be purchased online