Wilderness First Aid Q&A

How to prevent and treat skier’s thumb



skier-200x148Having recently examined a common snowboarding injury, let’s now turn to an injury that frequently occurs to those who navigate the slopes on skis – “skier’s thumb.” Although not as common as knee injuries, skier’s thumb isn’t far behind and accounts for about 1 out of 10 of all ski injuries.

skier-300x222Skier’s thumb is an injury to the ulnar collateral ligament (UCL), which runs between the two bones on the interior side of your thumb and holds the bones of the thumb together. The injury can occur when you fall on your outstretched hands while holding a ski pole, causing the thumb to either bend backwards or too far out to the side.

This type of thumb injury is also sometimes referred to as “gamekeeper’s thumb” because it was first seen in gamekeepers (people who work in the countryside to make sure there is enough game for hunting). It was noticed that many gamekeepers were getting chronic thumb injuries from wringing the necks of chickens and hares between their thumb and index fingers. You are much more likely to incur this as an acute injury when skiing rather than from chronic use – unless, of course, you decide to pursue the now-rare profession of gamekeeping!

As with any injury, the best treatment is to prevent it from occurring in the first place! There are a few easy steps you can take to drastically reduce your risk of skier’s thumb while enjoying the fresh powder this winter season. First, choose ski poles that have finger groove grips but also don’t have any sort of restraint such as a wrist strap. Also, hopefully when you learned how to ski, you were taught to let go of your poles if you do take a spill to reduce injuries of this nature.

Falling on outstretched hands in any situation puts you at risk for many upper extremity injuries, including injuries to the wrist, shoulder, hand and thumb. So how do you figure out if you have skier’s thumb? The most important clue is if you notice significant weakness or are completely unable to squeeze or hold things between your thumb and index finger (and it may be really painful since you have torn the ligament that controls that movement!). Your thumb will also be very likely to be sensitive to touch along the side of your thumb close to your index finger. There also can be swelling or bruising of the thumb, but these symptoms might not show up initially. If you have some of these symptoms along with pain in the wrist don’t yet rule out skier’s thumb and assume it’s a wrist injury only. You may still have a thumb injury and could be experiencing what is called “referred pain.” Referred pain is a complex phenomenon that causes you to feel pain at a location different from the original site of the injury. It is caused by the complex pattern of nerves that bring pain signals from the site of the injury to be processed by the central nervous system.

If you or a friend take a spill on the slopes and experience these symptoms, it is best to seek medical attention quickly. It is important to determine whether your fall also resulted in another injury such as a wrist fracture, which will need treatment fairly quickly. There are some actions you can take to lessen the pain while waiting to see the doctor. Take ibuprofen (Advil or Motrin) as soon as possible if you are medically okay to do so. This will help reduce the pain and can also reduce swelling of the thumb. You can also apply ice to the thumb for “20 minutes on and 20 minutes off” until you reach medical attention as this will also help with the pain as well as keep the swelling minimized. If you have an ACE bandage in your first aide kit, loosely wrapping the thumb can also help reduce the pain and swelling as well as protect the thumb from further injury.

Once you have been diagnosed with skier’s thumb, you will likely be referred to an orthopedic doctor who will be able to evaluate your injury and help you decide on a treatment option. Depending on the severity of your injury, the thumb may have to be immobilized in a brace or cast for a few weeks, or in more severe cases (or if the UCL is completely torn), surgery may be required.

Hopefully you can enjoy the mountains during this winter season without having to tour the local hospital! So bundle up, remember all the precautions you can take, and hit the slopes equipped with the knowledge of what to do if you have an unfortunate fall!

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  • Dr. Andrew C. Krakowski is the host of the boonDOCS Wilderness & Travel Medicine show on Outdoor Channel. He is the founder of the Johns Hopkins School of Medicine's wilderness medicine program and currently works in the field of pediatric dermatology at the Rady Children's Hospital in San Diego.

    Dr. K loves the outdoors and believes that knowledge, adaptability, and experience are essential for being prepared in the wilderness.

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