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Skier’s thumb

Other popular names

Gamekeeper's thumb

Who does it affect?

The acute injury to the thumb often occurs in collision sportspeople and is the second most common skiing injury in the upper limb.  The chronic injury is described as a gamekeeper's thumb, and this was thought to occur as gamekeepers killed the animals by breaking their necks, causing a strain to the thumb.

Why does it happen?

The acute injury occurs as the thumb is twisted violently and ruptures the thumb metacarpo-phalangeal ligament on the inside.

Symptoms

People present with pain on the inside of the thumb and also a sense of weakness of the thumb, due to instability.

Diagnosis

Identified as localised pain, often with a small amount of swelling, suggesting the ruptured end of the ligament.  Your consultant will gently move the thumb, and may notice increased laxity.

X-rays are performed, which may show a small fracture, but occasionally plain x-rays are normal. The consultant may perform stress x-rays, where local anaesthetic is placed around the thumb to numb the torn ligament, and this is then stressed whilst pain-free.  Increased movement, compared with the opposite side, would be suggestive of a ligament injury.  Ultrasound scans and MRI scans can also be performed to directly visualise whether the ligament has been injured.

Non-surgical treatment

The vast majority of ulna collateral ligament injuries to the thumb (skier's thumb) are treated operatively. This is on account of the fact that once the ligament snaps it flips onto the wrong side of a nearby tendon. This prevents the ligament ends from healing directly to each other.

Surgical treatment

Surgery is performed as a day case procedure and normally under general or regional anaesthetic.   A small (5 cm) incision is made on the inside of the thumb, and the ligament is directly repaired back to the bone, using a small bone anchor.

Post-surgery rehabilitation

You will be placed into a splint for the first week, and then supervised motion is permitted, with bending forwards and backwards of the thumb.  However, no stress is allowed to be performed on the healing ligament for the first eight weeks.

Return to normal routine

Generally speaking, this occurs over the first four to six weeks.

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