Skier's thumb is an injury to the main stabilising ligament on the inside of the thumb. The injury can cause pain, weakness and instability when gripping or pinching objects. Whilst many minor injuries heal with splinting, complete ligament tears often require surgical repair to restore thumb stability.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including ligament injuries, hand trauma, thumb arthritis and sports injuries.
What is Skier's Thumb?
Skier's thumb is a tear of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint. This is the joint where the thumb meets the hand.
The ulnar collateral ligament lies on the side of the thumb closest to the index finger and plays an important role in stabilising the thumb during gripping and pinch activities.
When the ligament tears, the thumb may become painful, weak and unstable, making many everyday tasks difficult.
What causes Skier's Thumb?
The injury usually occurs when the thumb is forced away from the hand during a fall.
It is particularly common in skiing accidents where the thumb catches against a ski pole, giving rise to the name Skier's Thumb.
However, the injury can occur during many sporting activities or after any fall onto an outstretched hand where the thumb is forced backwards or sideways.
What is Gamekeeper's Thumb?
Gamekeeper's Thumb affects the same ligament but develops differently.
Rather than occurring after one sudden injury, it develops gradually as repeated stress causes the ulnar collateral ligament to stretch and become incompetent.
Historically it was seen in gamekeepers who repeatedly wrung the necks of birds, gradually stretching the ligament over many years. Today it is much less common than Skier's Thumb.
Symptoms of Skier's Thumb
Symptoms vary depending on the severity of the ligament injury but commonly include:
- Pain on the inside of the thumb joint
- Swelling around the thumb
- Bruising after the injury
- Weakness during pinch grip
- Difficulty holding objects
- A feeling that the thumb is unstable or giving way
Many patients particularly notice weakness when picking up small objects, opening jars or turning keys.
How is Skier's Thumb diagnosed?
The ligament may be sprained (a partial tear) or completely ruptured.
Distinguishing between these injuries is important because complete tears are much more likely to require surgery.
Diagnosis usually involves careful examination of the thumb to assess stability and compare it with the opposite side.
If the diagnosis remains uncertain, an ultrasound scan may be helpful. Occasionally additional imaging such as MRI may also be considered.
Find out what to expect at your outpatient appointment.
Treatment for Skier's Thumb
Partial ligament tears
Partial tears usually heal successfully without surgery.
Treatment generally consists of:
- Rest
- Immobilisation in a thumb splint or cast
- Gradual return to activity once healing has occurred
Complete ligament tears
Complete tears are usually treated surgically.
In some patients the torn ligament becomes trapped above a nearby tendon called the adductor pollicis aponeurosis. This is known as a Stener lesion and prevents the ligament from healing naturally.
For this reason, complete tears are ideally repaired within three weeks of injury to give the best chance of successful healing.
The operation is performed through a small incision and is usually carried out as a planned day-case procedure under regional or general anaesthesia.
Following surgery, the thumb is immobilised in a cast or splint for approximately six weeks before rehabilitation begins.
Recovery after treatment
Following immobilisation, gradual thumb movement is encouraged.
Some patients benefit from hand therapy to restore movement, grip strength and pinch strength, although many recover well with a structured home exercise programme.
Recovery continues over several months and most patients regain excellent thumb function.
Read more about post-operative care.
Long-term outcome
Most ulnar collateral ligament injuries heal successfully and patients return to normal activities without long-term problems.
It is common to experience some stiffness following treatment, although this rarely causes significant functional limitation.
In a small number of patients the ligament does not heal satisfactorily or persistent instability develops. Further surgery, including ligament reconstruction or thumb joint fusion, may occasionally be required.
Pain or weakness after a thumb injury?
If you have injured your thumb and are experiencing pain, weakness or instability, Mr Robert Farnell can assess whether you have sustained a Skier's Thumb injury and advise whether splinting or surgical repair is appropriate.
Skier's Thumb FAQs
What is Skier's Thumb?
Skier's Thumb is a tear of the ulnar collateral ligament of the thumb metacarpophalangeal joint, usually caused by a fall.
What is Gamekeeper's Thumb?
Gamekeeper's Thumb affects the same ligament but develops gradually due to repeated stretching rather than a single injury.
What is a Stener lesion?
A Stener lesion occurs when the torn ulnar collateral ligament becomes trapped above the adductor pollicis aponeurosis, preventing normal healing. It usually requires surgical repair.
What are the symptoms of Skier's Thumb?
Symptoms include pain, swelling, bruising, weakness during pinch grip and instability of the thumb.
Do all ligament tears need surgery?
No. Partial tears usually heal successfully with splinting. Complete tears are more likely to require surgical repair.
How long is the thumb immobilised?
Following surgical repair, the thumb is usually protected in a cast or splint for approximately six weeks.
Will my thumb recover fully?
Most patients regain excellent thumb stability and function following appropriate treatment.