Skier’s thumb is an injury to an important stabilising ligament (the ulnar collateral ligament) of the ‘knuckle joint’ of the thumb (where the thumb joins the hand). The ulnar collateral ligament is responsible for stability and strength of the thumb when pinching or gripping. With injury to this ligament, you may feel pain and swelling at the joint where the thumb joins the hand, weakness of pinch and grip and soreness to touch around the inside of the joint in the webbing.
How do I know if I have skier’s thumb?
Skier’s thumb can be quite painful, especially when you grip or pinch something with the affected thumb.
The thumb joint will usually be swollen and sore to touch.
Any kind of stretch to the injured area, for example if the thumb gets caught on clothing, can cause pain and weakness.
Your physiotherapist will test the stability of the ligaments and determine the grade of the injury. An X-ray is required to check if the ligament has chipped off a fragment of bone. A device that measures your pinch strength is a good indicator on the severity of your injury and this will be used to monitor healing over time.
How can physiotherapy help with skier’s thumb?
A partial tear of the ulnar collateral ligament needs to be supported to heal. Your physiotherapist will usually need to fit you with a splint, which stops further injury and pain, but allows gentle function. You can usually use your hand for day-to-day activities, as comfortable, in the splint. A significant skier’s thumb injury may require six weeks of full-time splinting.
While the injury is improving, it is usually possible to start some strengthening exercises. Once the ligament has healed, the protection of the splint is needed less, and you will be ready to start strengthening the thumb. You will need to tape or splint for sport for several weeks or for the rest of the season, depending on the grade of the injury. Often a special sports guard is required for return to contact sports for additional protection.
It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.
How effective is physiotherapy for skier’s thumb?
In the case of partial tears, with good splinting and physiotherapy treatment, most people achieve full movement, strength and function.
Surgery is required for complete (grade three) tears with instability and also to fix a large fracture fragment. If surgery is required, physiotherapy is essential after the operation, to splint and support the repaired ligament, followed by gradual movement and strengthening.
What can I do at home?
First aid is rest, ice and compression for a soft tissue injury. If you think you may have a skier’s thumb, seek advice from a physiotherapist or GP as soon as possible. Avoid pinching and gripping with the thumb until it is protected in a splint.
The type and extent of the injury and the stability of the joint indicates what is safe to do. Suitable splinting, as guided by your physiotherapist, will ensure that you achieve good healing. At an appropriate time, regular exercises are essential to improve movement and strength.
How long until I feel better?
For partial tears, pain and function should improve as soon as the thumb is appropriately splinted. Mild sprains recover within days to weeks of treatment. More severe sprains and those requiring surgery take several weeks of constant splinting and may take a few months to achieve about 80–90 per cent strength.