Skier’s Thumb

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Injuries to the ulnar collateral ligament (UCL) of the thumb were first recognized as an occupational condition in European gamekeepers. By repetitively wringing the necks of game (eg, chickens) between their thumb and index finger, these workers produced a chronic stretching of the UCL that resulted in instability at the first metacarpophalangeal (MCP) joint. The condition became known as gamekeeper’s thumb. Today, the injury is primarily caused by acute (rather than chronic and repetitive) damage to the UCL, most often due to a skiing accident; hence, the condition is now commonly referred to as skier’s thumb.

For patient education resources, see the Hand, Wrist, Elbow, and Shoulder Center and Sports Injury Center, as well as Skier’s Thumb and Repetitive Motion Injuries.

United States

Skier’s thumb represents 5-10% of all skiing injuries; this condition is the most frequent injury of the upper extremity that skiers experience. [1, 2, 3, 4]

The MCP joint of the thumb is primarily stabilized by the UCL. The origin of this ligament is on the ulnar aspect of the metacarpal head, whereas the insertion of the UCL is located distally on the proximal phalanx.

The most common cause of UCL injury is an acute abducting (radially directed) force upon the thumb. [5] Damage may also result from a combination of torsion, abduction, and hyperextension at the first MCP joint. Depending on the degree of impact of these forces at the MCP joint, the UCL may either tear partially or completely (see the images below). [1, 2, 3, 4, 6]

A large number of skiing injuries are attributed to ski poles, in which the strap or sword grip lies across the palm and transmits the damaging force to the thumb during a fall. Football players may develop UCL damage either traumatically (eg, while making a tackle, falling on an outstretched hand [FOOSH injury]), or chronically (eg, linemen, who repetitively stress the thumb radially while blocking). The injury is also common among athletes who handle balls (eg, basketball, football) and among those who use sticks (eg, hockey, lacrosse), in which the sporting equipment can forcefully abduct the thumb during sport activity.

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Snider RK. The Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 257-9.

Aluisio FV, Christensen CP, Urbaniak JR, et al, eds. Orthopaedics. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 205-6.

Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg. 2009 Mar. 13(1):7-10. [Medline].

Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015 Jan. 34 (1):117-26. [Medline].

Mahajan M, Rhemrev SJ. Rupture of the ulnar collateral ligament of the thumb – a review. Int J Emerg Med. 2013 Aug 12. 6(1):31. [Medline]. [Full Text].

Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 2010 Mar. 20(2):106-12. [Medline].

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Koslowsky TC, Mader K, Gausepohl T, Heidemann J, Pennig D, Koebke J. Ultrasonographic stress test of the metacarpophalangeal joint of the thumb. Clin Orthop Relat Res. 2004 Oct. 115-9. [Medline].

Gurdezi S, Mok D. Sag sign’—A simple radiological sign for detecting injury to the thumb ulnar collateral ligament. Injury Extra. 2008.

Plancher KD, Ho CP, Cofield SS, Viola R, Hawkins RJ. Role of MR imaging in the management of “skier’s thumb” injuries. Magn Reson Imaging Clin N Am. 1999 Feb. 7(1):73-84, viii. [Medline].

Jones MH, England SJ, Muwanga CL, Hildreth T. The use of ultrasound in the diagnosis of injuries of the ulnar collateral ligament of the thumb. J Hand Surg [Br]. 2000 Feb. 25(1):29-32. [Medline].

Schnur DP, DeLone FX, McClellan RM, Bonavita J, Witham RS. Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg. 2002 Jul. 49(1):19-22; discussion 22-3. [Medline].

Hergan K, Mittler C, Oser W. Pitfalls in sonography of the Gamekeeper’s thumb. Eur Radiol. 1997. 7(1):65-9. [Medline].

Susic D, Hansen BR, Hansen TB. Ultrasonography may be misleading in the diagnosis of ruptured and dislocated ulnar collateral ligaments of the thumb. Scand J Plast Reconstr Surg Hand Surg. 1999 Sep. 33(3):319-20. [Medline].

Gherissi A, Moussaoui A, Liverneaux P. [Is the diagnosis of Stener’s lesion echograph-dependent? A series of 25 gamekeeper’s thumb] [French]. Chir Main. 2008 Oct. 27(5):216-21. [Medline].

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Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical of skier’s thumb injuries: case report and review of the literature. Mt Sinai J Med. 2006 Sep. 73(5):818-21. [Medline].

Milner CS, Manon-Matos Y, Thirkannad SM. Gamekeeper’s thumba -oriented magnetic resonance imaging classification. J Hand Surg Am. 2015 Jan. 40 (1):90-5. [Medline].

Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. Mar 2010. 20(2):106-12. [Medline].

Cooper JG, Johnstone AJ, Hider P, Ardagh MW. Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries. Emerg Med Australas. 2005 Apr. 17(2):132-6. [Medline].

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Musharafieh RS, Bassim YR, Atiyeh BS. Ulnar collateral ligament rupture of the first metacarpophalangeal joint: a frequently missed injury in the emergency department. J Emerg Med. 1997 Mar-Apr. 15(2):193-6. [Medline].

O’Callaghan BI, Kohut G, Hoogewoud HM. Gamekeeper thumb: identification of the Stener lesion with US. Radiology. 1994 Aug. 192(2):477-80. [Medline].

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Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Jonathan Raanan, MD Assistant Professor of Physical Medicine and Rehabilitation, Department of Neurosurgery, Stony Brook University Medical Center

Jonathan Raanan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Todd P Stitik, MD Professor, Department of Physical Medicine and Rehabilitation, Director, Outpatient Occupational/Musculoskeletal Medicine, Rutgers New Jersey Medical School

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Ossur, Fidia.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

Dena Abdelshahed Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Greg Gazzillo Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Gloria E Hwang, MD, MPA Rutgers New Jersey Medical School

Disclosures: Nothing to disclose.

Debra Ibrahim New York College of Osteopathic Medicine

Disclosure: Nothing to disclose.

Evish Kamrava St George’s University School of Medicine

Disclosure: Nothing to disclose.

Jason Lee St George’s University School of Medicine

Disclosure: Nothing to disclose.

Leia Rispoli, MD Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Dev Sinha American University of Antigua School of Medicine and Health Sciences

Disclosure: Nothing to disclose.

Skier’s Thumb

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