Skier's thumb
What is Skier's thumb?
Skier's thumb is an injury to the ulnar collateral ligament of the thumb metacarpophalangeal joint. It occurs when the thumb is forced away from the hand, commonly during skiing falls, ball sports or contact injuries.
Common symptoms
Symptoms include pain and swelling on the inner side of the thumb knuckle, bruising, weakness with pinch, difficulty gripping objects and a sense that the thumb is unstable or giving way.
Diagnosis and imaging
Examination assesses tenderness and ligament stability, often compared with the other thumb. X-rays check for an associated avulsion fracture. Ultrasound or MRI can identify complete tears and a Stener lesion, where the ligament cannot heal in the correct position.
Non-surgical treatment
Partial, stable tears can often be treated with thumb immobilisation followed by hand therapy. The thumb must be protected long enough for ligament healing before pinch and sport are resumed.
Surgical treatment
Complete unstable tears, displaced avulsion fractures and Stener lesions usually require surgical repair. The aim is to restore a stable thumb for pinch, grip and sport.
Recovery and follow-up
After repair, the thumb is protected in a splint or cast, then movement and strengthening are introduced gradually. Return to contact sport or heavy pinch is delayed until stability and strength return.
Skier's thumb FAQs
What is a Stener lesion?
It occurs when the torn ligament is displaced superficial to the adductor aponeurosis, preventing normal healing. This usually requires surgery.
How is skier's thumb diagnosed?
Diagnosis starts with a focused history and examination, then uses imaging selectively to confirm the pattern of injury, exclude related problems and plan treatment accurately.
Can I keep using the thumb if it feels unstable?
Ongoing instability can lead to weak pinch and chronic joint problems. It is best to have significant injuries assessed early.
Will I need surgery for skier's thumb?
Many patients improve without surgery. Surgery is considered when symptoms remain limiting despite appropriate non-surgical care, when there is significant structural damage, or when delay may compromise function.
When can I return to skiing, ball sport or contact sport?
Return depends on the diagnosis, treatment type, tissue healing and the physical demands of the activity. The plan is usually staged, with strength, range of motion and confidence rebuilt before unrestricted loading.
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