The cold weather is fast approaching and skiers will soon be itching to hit the slopes. As with all sports, skiing has an inherent potential for injuries to occur. The most common type of skiing injuries affect the knee ligaments and cartilage and occur approximately twice as often as injuries to the thumb, also called skier's thumb. The focus of this report will be on the skier's thumb.

Skier's thumb is actually a sprain to the ulnar collateral ligament of the thumb which lies on the inside aspect of the knuckle joint of the thumb closest to the hand. This ligament supports the medial or inner aspect of the thumb's metacarpophalangeal joint from being pulled too far outward away from the hand.

How can this ligament be sprained while skiing you ask? It can be as simple as falling onto the hand while holding a ski pole. The ski pole handle acts as a fulcrum on the outstretched thumb applying a force across the joint stretching the ulnar collateral ligament. This can result in a grade 1 or 2 sprain or partial tear, or a more serious complete tear or grade 3. Pain is localized to the joint over the ligament with grade 1 and 2 sprains, especially with movements that further stretch the ligament. In the case of grade 3 sprains, pain is minimal if any as the ligament is completely torn. The thumb can be abnormally overstretched away from the hand creating an unstable joint. A small piece of bone can also become detached along with the ligament in the case of grade 3 sprains.

The seriousness of this type of injury is often overlooked by the victim as being insignificant. However, the thumb is the most important joint in the hand and if left untreated, this type of injury can result in an unstable thumb and chronic pain. If this type of injury is suspected, the thumb should be x-rayed to rule out a fracture. In the case of grade 3 sprains surgery is done to reattach the ligament and any bony fragment that may be present. The hand is immobilized for a period of time and followed up with a course of physiotherapy treatment to regain full range of motion and strength. Grade 1 and 2 sprains are treated with immobilization in a cast or splint for 6-8 weeks and again followed-up with physiotherapy to regain full range of motion and strength.

Skiing without wearing the pole straps is the best prevention for this type of injury so that the ski pole will fall away from the hand in the event of a fall. Strapless or grip poles have not been found to be any better in preventing this type of injury from the conventional type poles with straps.

A sprained thumb left untreated can lead to chronic ligament laxity and chronic pain. It is important to have a sprained thumb checked out by a health care professional. Following this type of injury treatment initiated sooner has better outcome results than a ligament injury that has been left untreated for months.

References:

1. http://www.orthosports.com.au/hand_skier.html
2. http://www.ski-injury.com/alpine.htm
3. http://snakeriverlodge.rockresorts.com/info/act.skiing.asp