Ski Thumb

Ski Thumb

The ski thumb refers to a tear in the inner lateral ligament of the thumb. This injury is typical for skiers, but also often occurs during ball sports. A ski thumb must be treated, otherwise the thumb loses its functionality.

What is a ski thumb?

A ski thumb is a colloquial term for a tear in the collateral ligament at the base of the thumb. The medical term for this is ulnar (on the elbow side) collateral ligament rupture (rupture = tear) or rupture of the ulnar collateral ligament. For what does hoc mean, please visit etaizhou.info.

The ulnar collateral ligament, along with other ligaments and structures, stabilizes the metatarsophalangeal joint and runs on the side of the thumb that faces the rest of the fingers. Excessively spreading the thumb away from the hand leads to excessive stretching of this collateral ligament. If the load capacity of the band is exceeded, it tears.

The term ski thumb comes from the fact that this collateral ligament tear often happens to skiers when they fall and try to catch themselves with their hands or when their thumb gets caught in the loop of the ski pole. In both cases, the thumb is hyperextended towards the radius. The tear can occur in three different places on the ligament; close to the base of the thumb, in the middle or close to the metacarpal bone.

Causes

The cause of the ski thumb is an excessive spread of the thumb from the hand and the associated overstretching of the lateral ligament at the base of the thumb. This happens very often when skiing.

But ski thumbs can also occur in other sports. If a ball thrown with force is caught during ball sports, the thumb can be stretched back so far that the collateral ligament tears.

Other possible causes of the ski thumb are a fall that you reflexively catch with your spread hand, overstretching of the thumb during floor or apparatus gymnastics or martial arts.

Symptoms, Ailments & Signs

A tear in the collateral ligament causes a variety of symptoms. A clear cracking noise can often be heard during the accident. This is immediately followed by a violent shooting pain in the thumb and in the metatarsophalangeal joint. Since a torn ligament also affects the surrounding tissue and vascular injuries occur, blood leaks into the tissue and a bruise (hematoma) forms.

This in turn leads to swelling of the thumb and increased sensitivity to pressure, especially in the metatarsophalangeal joint. The joint is unstable, abnormally mobile and hinged. If it can be opened to more than 30°, this is a significant indication of a collateral ligament tear. The thumb feels weak and also folds sideways when moving, so that it can only be used to a limited extent for gripping and pressing.

Any attempt to grasp is painful. If the accident occurs on the piste, the person affected will notice immediately that they can no longer hold the ski pole. The pain will subside after a few days, but permanent discomfort can occur if the injury is not treated. If the instability of the thumb persists, the base joint of the thumb will be overloaded over time and wear out in an unphysiological way, which can lead to joint wear and tear ( arthrosis ). The stiffening of the joint is also possible.

Diagnosis & History

The ski thumb makes itself felt immediately through a sharp shooting pain. Sometimes a popping sound can be heard as the tape breaks. After the accident, the metatarsophalangeal joint is no longer stable.

The thumb has a side band both inside and outside. If the inner collateral ligament is torn, the thumb can be opened outwards. Because the torn ligament and possibly other injured structures bleed, bruising (hematoma) forms after the rupture and the tissue around the thumb swells. After the first severe shooting pain, a permanent pain sets in as the disease progresses. A gripping movement with the thumb is no longer possible and every movement hurts.

The doctor usually suspects a collateral ligament tear based on the course of the accident and the fact that the thumb can be folded open. A mobility test is always difficult because it causes pain. An x-ray can be used to determine whether there are additional bone injuries. With the MRT examination (magnetic resonance tomography), the ski thumb can be diagnosed without a doubt, since the structures of the ligament are also visible here.

Complications

A ski thumb is primarily noticeable through severe pain. Other complications can arise if the injury is not treated promptly. This can lead to permanent movement restrictions of the thumb. Symptoms of paralysis and sensory disturbances are also typical. A bruise can cause skin damage or frostbite if not treated properly.

Inflammation can also occur, which in the worst case can result in a scar on the ball of the hand. The collateral ligament tear itself does not otherwise pose any risks. However, it always leads to restricted mobility, which significantly restricts those affected in everyday tasks. Careless behavior can cause the injury to reopen and require re-treatment. In the surgical treatment of a collateral ligament tear, the main complications and risks are possible infections.

These usually manifest themselves as swelling and redness in the surgical area, combined with pain and sensory disturbances. In individual cases, there may be an injury to skin nerves in the area of ​​the operation. As a result, knot-like thickening can form, which is associated with sensory disturbances and other complaints. Prescribed painkillers occasionally cause side effects and interactions.

When should you go to the doctor?

In addition to mouse arm, tennis elbow or snowboarder’s ankle, the ski thumb is also a typical sports injury. The collateral ligament rupture of the thumb occurs primarily in skiers. But it can also occur in all other sports accidents in which the thumb was spread wide.

The collateral ligament tear is due to severe overstretching. Occasionally, a piece of the thumb bone is also affected. Either way, the visit to the doctor should take place as soon as possible after the accident, because the thumb is indispensable in our lives. Immobilization of the thumb or the entire hand is recommended immediately after the accident. Cooling is also useful. It prevents severe swelling.

A quick visit to the doctor is therefore essential because non-observance can result in consequential damage. As a result of injuries that are not treated, arthrosis of the metacarpophalangeal joint, permanent misalignments of the thumb or persistent joint instability with persistent pain and restricted movement can occur.

In most cases, surgical repair of the ski thumb is necessary. In some cases, conservative splinting and immobilization can suffice. However, this is only possible if the problem is overstretching or a crack. If the collateral ligament is torn, surgery on the affected thumb is unavoidable. Even a bone chip can be treated conservatively, provided the collateral ligament is intact.

Treatment & Therapy

The ski thumb should first be immobilized, cooled and elevated for acute treatment. If the ligament is not completely torn, further treatment can be conservative (without surgery). The thumb is immobilized with a splint for about four to six weeks. After that, the musculature must be slowly trained again with physiotherapy exercises in order to restore the original stability and functionality of the thumb.

In the case of a complete tear of the collateral ligament or if additional bone parts have been torn off, an operation is unavoidable. Depending on the type of tear, the surgeon uses different techniques. If the band is torn in the middle, it is usually reassembled and fixed with a seam. The joint of the thumb is temporarily fixed with a so-called Kirschner wire to ensure complete immobilization.

The wire is later removed under local anesthesia. If the ligament is torn to such an extent that it can no longer be sewn together, it is replaced by an endogenous tendon. Bone parts that have been torn off are fixed again with screws or wires. A rest period must also be observed after the surgical treatment of the ski thumb. After that, physical therapy exercises can begin.

Prevention

You can only prevent a ski thumb to a limited extent. Since it often happens in certain sports, it makes sense to wear a tape bandage around the thumb to stabilize it and protect it from overstretching.

Aftercare

If the ski thumb has to be operated on due to a complete rupture of the ligaments, it is then immobilized for several weeks. It takes between two and six weeks before the cast can be removed again. The patient then receives a special orthosis. It makes the physiotherapeutic or ergotherapeutic follow-up treatment easier.

In order for the doctor to be able to check the operation wound, the cast must be changed every two to three days after the operation. The threads are then pulled. In order to support the healing of the wound, it is advisable to apply a greasy cream to the scar in the first few months. This procedure counteracts the growth of excess tissue that causes pain or tension.

If movement restrictions appear after the surgical intervention on the ski thumb, physiotherapeutic follow-up treatment is necessary. The patient carries out an independent movement therapy in warm water for about six weeks. He also puts on a thumb bandage for support.

When doing physiotherapy, it should be noted that it must not cause any pain or swelling in the affected thumb. Excessive treatment is considered counterproductive.

Patience is required until the hand and thumb function normally again. It usually takes a few weeks before you can go back to your usual everyday activities. It usually takes three to four months before you can do sports again.

You can do that yourself

In the case of existing health impairments, sufficient protection and rest for the hand and the joint is particularly important. The gripping function of the affected hand should be used less or not at all during the healing process. In everyday life, therefore, various tasks have to be restructured or the execution of the activities has to be changed. It is advisable to use the symptom-free hand more often in order to protect the diseased metatarsophalangeal joint. Situations of stress or stress are to be avoided completely.

If the woman is not sufficiently rested, the symptoms can increase and, in the case of an unfavorable course of the disease, the joint can stiffen. This means that the gripping function takes on irreparable damage and remains limited for life.

It is advisable to ask relatives or people in your social environment for help with a large number of everyday activities. There is little conducive to the recovery process if numerous activities involving the thumb are carried out despite the adversity. When carrying out professional activities, the physical limitation must be pointed out in good time. The environment should be informed about the health impairments so that misunderstandings and conflicts can be reduced to a minimum. Skiing or other sporting activities are to be avoided during the recovery period.

Ski Thumb