The condition commonly known as skier’s thumb is a frequently occurring thumb ligament injury. It can be caused during a fall on outstretched thumbs, for example during a fall while gripping a ski pole or it can occur in any circumstances where there has been forced abduction of the thumb (thumb forcefully moved away from palm). The ulnar side thumb ligament can be completely torn off, partially or completely ripped or hyperextended, in other words, pulled. If the ligament is torn, apart from the obvious pain and bruising there is abnormal flexibility and swivelling of the thumb’s basal joint because the ripped ligament no longer stabilizes the thumb. A firm grip is therefore often not possible. An x-ray is essential to rule out any fragmented bone fracture. As immediately after injury it is often not possible to diagnose straight away because of the pain, a new clinical examination should follow a few days after immobilisation of the thumb. In this examination, a comparison of both thumbs is important as the stability and mobility of the basal joints can be varied and individual.
Conservative therapy is only possible if the ligament is only partly torn or pulled or if there are non-displaced fractures. In these cases, splinting of the thumb for 5-6 weeks should be adequate. In all other cases, surgical intervention is recommended as the hand’s function can be severely limited and due to chronic instability it could lead to joint wear (osteoarthritis).
The goal of the operation is the firm reattachment of ligament to bone. Often, the ligament has been completely ripped from the bone and must be anchored with a special anchor called a Mitek anchor, which remains in the bone. In the case of displaced bone fragments, these are screwed back onto the bone or are fixed using a special suturing technique. Whatever the surgery, it will be necessary to immobilize the thumb in plaster or an orthesis for 6 weeks. Afterwards the thumb can, over a period of a few weeks, recover ability to deal with daily activities under stress. Full mobility adequate enough to withstand sports activities requires approximately 3 months.