Thursday, 11 February 2016

Skier's thumb

What is it, what are the symptoms and how can you avoid it?

What a week of mixed conditions.  From snow storms with crazy winds to beautiful blue bird powder days.  We're in full swing of the winter holidays and with half term fast approaching we would like to provide further education as to injury prevention, so this week we are discussing skier's thumb.

We don't actually see a lot of people with this injury, but it doesn't mean they don't happen.  It is actually the most common upper extremity injury in skiers. So, why do we not see may people with this condition at Bonne Santé?  Well, skier's thumb is easily missed, often ignored when it is a minor injury and may require surgery when major damage is caused, therefore people are more likely to be seen in the medical centre and repaired in the hospital.  Because there is a high risk of avulsion fracture (when the ligament pulls of a flake of bone), an x-ray is usually recommended when this injury occurs.  

Skier's thumb is an injury which occurs to the stabilising ligaments of the thumb and usually happens when you fall onto an outstretched thumb.  The thumb is yanked into abduction (a sideways strain). It is called skier’s thumb as it often happens when a person falls while holding onto a ski pole with the thumb outstretched. It also occurs in athletes who play ball sports (eg, basketball, football) where the ball can forcefully overstretch the thumb during sport activity.  Even snowboarders can be affected, but this happens less commonly.

The ulnar collateral ligament of the metacarpophalangeal (thumb) joint is either partially or completely torn. This ligament supports the thumb when pinching or gripping and if it is damaged may lead onto to a chronic instability of the thumb causing problems with daily function. It's a pretty important ligament. 
What are the symptoms?
  • Swelling around the thumb
  • Bruising in the injured area
  • Weakened pinch grip
  • Difficulty holding objects
  • Tenderness to touch  

How is it diagnosed?
  • A detailed history will be taken, specifically to find out how what the mechanism of injury was and how recently you did it.  
  • A physical examination will be carried out which will test for the laxity of the ulnar collateral ligament of the thumb.  The ligament will be stressed to help ascertain the extent of the damage. The movement will be compared to your other thumb. 
  • The thumb will be palpated for specific areas of tenderness
  • An x-ray will performed to rule out a fracture. 
  • Your sensation may also be checked to rule out nerve damage. 
What is the treatment?

The treatment for skiers thumb depends upon the extent of you injury. Ice can be used to ease pain and swelling.  

For a partial tear of the ligament, wearing a splint is usually required for 4 - 6 weeks followed by physiotherapy and exercises to get the thumb moving again and restore strength.  Physiotherapy may include: 
  • Soft tissue work 
  • Scar massage
  • Manual therapy and mobilisations
  • Strengthening exercises
  • fine motor skills
For a complete rupture, ligament repair surgery is necessary. This would then be followed by a period of splinting and physiotherapy.

How to avoid Skiers thumb?

I personally never ski with the straps on the poles around my wrists.  That way, if / when I fall I can discard the poles so there is less chance of the force going directly through my hand and thumb.   This is a personal choice and may not be ideal if you are skiing in powder as you will be at risk of losing your pole, but I value my thumbs too much.  

If you do suffer a fall when you're away and think you may have suffered this type of injury, seek medical attention. Your thumb plays a crucial role in the function of your hand and seeking help quickly will offer the best chance of a full recovery.

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management. Bonne Santé physiotherapy has made every effort to provide you with correct, up-to-date information.  In using this blog, you agree that information is provided 'as is, as available', without warranty and that you use the information at your own risk.  We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues. 


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