It’s that time of year when the temperature drops and the snow starts to fall in the mountains. This makes for the perfect landscape to pursue snow sports including skiing, snowboarding, snowshoeing, and more. Skiing in particular is a wildly popular sport and some evidence suggests that its origins started around 6000 BC. Regardless of the exact date, soon after skiing was invented it’s likely humans began experiencing thumb ligament injuries.
The basics of thumb ligament injuries
The thumb is the most important digit of the hand and many ligaments help perform pinching and opposition tasks. Skier’s thumb refers to one particular thumb ligament injury involving the ulnar collateral ligament. This very important structure connects the thumb metacarpal to the proximal phalanx at the level of the joint (the thumb metacarpal phalangeal joint). It helps resist the forces that the thumb encounters during a fine pinch. If you pinch your thumb and index finger together, the pressure you feel in your thumb is your intact thumb metacarpal phalangeal ulnar collateral ligament (UCL). This ligament is also important for heavy grip, which is used to hold ski poles, and that is why it is commonly injured during skiing accidents.
As an avid winter sports person, I have seen many “yard sales” over the years. Fortunately, I have not injured my thumb, but falling on an outstretched hand while holding a ski pole creates the necessary force to stress the thumb and stretch or tear the ligament. Interestingly, simply falling on an outstretched hand with an empty palm typically doesn’t result in the same injury. Although we call this condition “Skiers Thumb,” any accident in which the thumb is abnormally bent backward or to the side can result in this specific injury.
What kinds of treatments are there for thumb UCL injuries?
Skier’s thumb injuries can present as partial or complete tears of the ulnar collateral ligament. Most of the partial tears are amenable to treatment with a cast or splint. A period of immobilization can be enough to allow the ligament time to heal. Complete tears require surgical repair, especially when surrounding soft tissue becomes stuck in the space between the two ligament halves. This specific complication is known as a Stener’s lesion.
Seeing one of Proliance Hand, Wrist and Elbow Physician’s surgeons can help quickly and accurately diagnose your thumb. As with many issues in hand surgery, the best results from surgery generally happen in the first 6 weeks. This is due to the ligament retraction that happens naturally when a repair is delayed. The standard of care in complete ulnar collateral ligament tears is surgical repair using a variety of methods, followed by 4-6 weeks of casting. Many patients also require significant rehabilitation with a certified hand therapist to regain thumb range of motion and strength.
But wait, isn’t this the same thumb ligament injury that Drew Brees of the New Orleans Saints had?
It is! Both Drew Brees and Matthew Stafford suffered similar injuries to the thumb on their throwing hand in recent NFL seasons. And it was recently announced that Jimmy Garoppolo has a significant injury in his right thumb. Multiple reports have claimed that he also has a thumb UCL injury but this has yet to be confirmed.
Why is the rehab so long if professional football players can return to the field four weeks after an injury?
There are many reasons we should not compare ourselves to professional athletes, but this exact question is the focus of research under Dr. Steve Shin of Kerlan Jobe Institute in Los Angeles. Newer techniques are constantly being adapted and modified for hand surgery applications, and Dr. Shin is among surgeons at the forefront of this work.
Of particular interest is Dr. Shin’s work on thumb ligament injuries, during which he uses suture tape to improve the strength of the repair. His recent collaboration involves a cadaver proof of concept whereby ligaments appear to be more stable after repair than they were prior to the injury. At the time of publication, the research hypothesized that this new technique might allow for earlier rehabilitation. A follow-up study of 17 athletes ranging from collegiate-level to professional-level later confirmed this theory. It found that this treatment allowed athletes to return to the same level sport at an average of 36 days.
If we apply Dr. Shin’s techniques to winter sports athletes, a thumb ligament injury may not necessarily ruin an entire ski season after all.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine how to best treat your thumb ligament injury. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices. This allows you to see both your hand surgeon and therapist in a single visit. Whether it is time for a cast, a therapy program, or even a surgical correction, our staff can help.
Contact us to make an appointment at any of our five convenient Eastside locations.
About the Author:
Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.
