University of Virginia Health System

The most common skiing injury of the upper extremity is "skier's thumb." This is an acute injury that occurs when a skier falls while his or her wrist is strapped to a ski pole. During the fall, the tendency is to try to release the pole and extend the hand to break the fall. This leaves the thumb extended with the pole resting in the web space between the thumb and the index finger. The thumb is then hyperextended and deviated to the side (abducted) at the moment of impact. This results in an injury to the ligament on the inside of the thumb that is responsible for stabilizing the thumb during pinch and grip. This same injury can occur when the skier plants the pole and fails to clear it again as they progress forward.

Signs and Symptoms
The skier will notice acute pain and swelling over the base of the thumb. The thumb will be diffusely tender but will hurt maximally over the inside of the joint toward the web space. Also, there may be tenderness and swelling over the base of the thumb in the palm. Attempts at pinching with the affected thumb will be painful and may result in "instability" or collapse of the thumb. The skier may find that he or she is unable to grip the pole following injury.

The degree of discomfort and weakness will depend on the severity of the injury. These injuries range from minor sprains to complete tears of the ligament. These injuries can also be associated with a fractures of the base of the thumb and should always be x-rayed.

Treatment
These injuries produce few long-term problems when they are treated early and appropriately. They are however, often "self-treated" with hope that "it is just a sprain and it will get better with time …" When these injuries are presented to the physician in the chronic phase, the treatment results are far less satisfying.

Treatment in the acute phase will depend on the severity of the injury. This will be determined by physical examination and x-ray evaluation that may include special x-rays taken while stressing the ligament. If the injury is determined to be a sprain (partial tear), treatment will usually consist of 4 - 6 weeks of bracing ina specially molded splint. Activity modifications may be minimal during this time. For more severe sprains and some complete tears, a cast may be applied for 4 - 6 weeks.

In a significant number of cases, complete tears require surgery to correct the problem. Fortunately this surgery has an excellent success rate with almost no functional deficit following healing.

The real key in minimizing the potential problems associated with this injury is early evaluation and appropriate treatment. This approach will facilitate your earliest return to your sporting activities.