What is Skiers Thumb

A ligament is a strong band of tissue that connects and supports bones. Ulnar collateral ligament (UCL) injury happens when the UCL at the base of the thumb is stretched or torn. A tear can be either partial or complete. The severity of the injury depends on how much of the ligament was damaged or torn.

The UCL ligament is important for normal use of the thumb. This ligament helps you to use and move your thumb. UCL injury can happen suddenly (acute injury) or gradually (chronic injury) with repeated overstretching of the ligament. If it is not treated properly, UCL injury can lead to arthritis.

What are the causes?

This injury is caused by forcefully moving the thumb past its normal range of motion toward the wrist. If you extend your hands to catch an object or to protect yourself while falling, the force of the impact can cause your ligament to stretch too much. This excess tension can also cause your ligament to tear.

What increases the risk?

This injury is more likely to occur in:

• People who have had a previous thumb injury or sprain.
• People who play contact sports or sports that involve catching balls, such as baseball, basketball, or football.
• People who do activities that increase the chance that the thumb will be pulled away from the rest of the hand.
• People who have poor hand strength and flexibility.
• People who do not warm up properly before activities.

What are the signs or symptoms?

Symptoms of this injury include:

• Pain or tenderness over the injured area with movement of the thumb.
• Pain when the injured area is pressed.
• Bruising or redness at the base of the thumb. This can spread to the whole thumb and part of the hand.
• Swelling over the injured area.
• Difficulty grasping or pinching with the injured thumb due to weakness or pain.

If the injury is severe, a lump (mass) may be felt under the skin in the injured area.

How is this diagnosed?

This injury is diagnosed with a medical history and physical exam. You may also have imaging studies, including:

• X-ray.
• Ultrasound.
• MRI.

How is this treated?

Treatment varies depending on the severity of your injury. If the UCL is overstretched or partially torn, treatment usually involves keeping your thumb in a fixed position (immobilization) for a period of time. To help you do this, your health care provider will apply a brace, cast, or splint to keep your thumb from moving until it heals.

If the UCL is fully torn, you may need surgery to reconnect the ligament to the bone. After surgery, a cast or splint will be applied and it will need to stay on your thumb while it heals.

Your health care provider may also suggest exercises or physical therapy to strengthen your thumb.

Follow these instructions at home:

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Report any concerns to your health care provider. You may put lotion on dry skin around the edges of the cast. Do not apply lotion to the skin underneath the cast.
• Keep the cast clean and dry.

If you have a splint or brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen it if your fingers become numb and tingle, or if they turn cold and blue.
• Keep the brace or splint clean and dry.

Bathing

• Cover the cast or splint and bandage (dressing) with a watertight plastic bag to protect it from water while you take a bath or shower. Do not let the cast or splint and dressing get wet.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a cast, splint, or brace on your hand.

General instructions

• Do not put pressure on any part of your cast or splint until it is fully hardened. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• Do not wear rings on your injured thumb.
• Do any exercise or physical therapy as told by your health care provider.

Contact a health care provider if:

• Your pain is not controlled with medicine.
• Your bruising or swelling gets worse.
• Your cast or splint is damaged.
• Your thumb is numb or blue.
• Your thumb feels colder than normal.

Skiers Thumb Repair

Skier’s thumb repair is a surgical procedure to repair a stretched or torn ligament in the thumb. Ligaments are strong bands of tissue that connect bones. The ligament that is injured in skier’s thumb (ulnar collateral ligament) connects the bones that make up the joint at the base of the thumb. This type of injury can result from falling with your hand outstretched. It often happens to skiers who fall with ski poles in their hands.

You may need this procedure if the torn ligament makes your thumb unstable. In this procedure, the surgeon will use stitches (sutures) to repair the ligament. If needed, the surgeon may also fix damage to bones in the area. This surgery can help you regain the function and stability of your thumb.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Stiffness or weakness.
• Pain.
• Numbness.
• Injury to blood vessels or nerves.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• You may have an exam or testing. Tests may include:
  • Blood tests.
  • Imaging tests such as X-rays or an MRI.
• Ask your health care provider what steps will be taken to help prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• Your surgeon will make an incision at the base and inside portion of your thumb, near the top of your wrist. This is done to locate the torn ligament.
• Any small bone fragments will be removed.
• The torn ligament will be stitched back together or stitched to the bones of your thumb joint.
• Any bone fracture that occurred will be fixed with wires or screws.
• The incision may be closed with stitches (sutures) or staples.
• Your hand may be placed in a cast or splint to keep the thumb from moving (immobilize the thumb) while it heals.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You may have to wear a cast or splint to keep your thumb from moving.
• Do not drive for 24 hours if you were given a sedative during your procedure.

Summary

• Skier’s thumb repair is a surgical procedure to repair a stretched or torn ligament in the thumb. This may help you regain function and stability.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Your hand may be placed in a cast or splint to keep the thumb from moving while it heals.

Skier’s Thumb Repair, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and tenderness.
• Thickness on the inner side of the thumb at the first knuckle. This may last for up to a year.
• Numbness.
• Swelling.
• Bruising.

You may need to wear a cast for up to 4 weeks. After the cast is removed, you may need to wear a removable splint.

Follow these instructions at home:

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean and dry.

If you have a splint:

• Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
• Keep the splint clean and dry.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths.
• If your cast or splint is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness
  • More swelling or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Ask your health care provider when it is safe to drive if you have a cast or splint on your hand.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Follow instructions from your health care provider about avoiding any activities that stretch your thumb joint. You may have activity restrictions for up to 4 months.
• Do exercises as told by your health care provider.
• Do not use your injured hand to support any part of your body weight until your health care provider says that you can.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• Your pain medicine is not helping.
• Your symptoms do not improve.
• You have a plaster cast that cracks or becomes wet or soft.
• You have a fiberglass cast or splint that remains wet for more than 24 hours.
• Your skin around the cast or splint becomes red.
• Your cast smells bad or becomes stained from the inside.
• You have any signs of infection in the incision area.

Get help right away if:

• Your pain is getting worse and is not relieved by pain medicine.
• Your thumb or your other fingers become numb, cold, and blue.

Summary

• Wear your cast or splint as told by your health care provider.
• Follow the activity restrictions given to you by your health care provider.
• Keep all follow-up appointments. This is important.