eMedicine Specialties > Sports Medicine > Wrist and Hand
Skier's Thumb: Follow-up
Updated: Mar 19, 2009
Follow-up
Return to Play
In addition to the 6-8 weeks of immobilization with casting or splinting, the patient with skier's thumb should avoid activities that risk reinjury for approximately another 6 weeks. An orthosis can be fitted to protect the patient's thumb to prevent further delay in return to activity.
Complications
Osteoarthritis of the first MCP joint may occur in patients with skier's thumb.
Prevention
A small dorsal (or radial) gutter splint can be designed to fit within the glove of skiers and other athletes.
Prognosis
When properly treated, patients with a UCL injury have a good prognosis for returning to their premorbid level of functioning. A missed diagnosis that delays the repair of a complete UCL rupture leads to a less favorable prognosis.
Miscellaneous
Medicolegal Pitfalls
- In traumatic cases of UCL injury of the thumb, to avoid inadvertent displacement of the involved bone, stress testing should not be performed until radiographs have ruled out an undisplaced fracture.
- A missed diagnosis that delays the repair of a complete UCL rupture can lead to a less favorable prognosis.
Greg Gazzillo, 4th year medical student, New Jersey Medical School–UMDNJ, Class of 2007, assisted with the 2006 revision of this manuscript.
Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 revision of this manuscript.
Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.
More on Skier's Thumb |
| Overview: Skier's Thumb |
| Differential Diagnoses & Workup: Skier's Thumb |
| Treatment & Medication: Skier's Thumb |
Follow-up: Skier's Thumb |
| Multimedia: Skier's Thumb |
| References |
| Further Reading |
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References
Connolly JF. Dislocations of the thumb and fingers. Fractures and Dislocations - Closed Management. Vol 2. Philadelphia, Pa: WB Saunders Co; 1995:1508-9.
Nicholas JA, Hershman EB. The Upper Extremity in Sports Medicine. St. Louis, Mo: Mosby; 1995:557-64, 598-9, 873.
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. Mar 2009;13(1):7-10. [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. Apr 2005;17(2):132-6. [Medline].
Koslowsky TC, Mader K, Gausepohl T, et al. Ultrasonographic stress test of the metacarpophalangeal joint of the thumb. Clin Orthop Relat Res. Oct 2004;427:115-9. [Medline].
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. Feb 1999;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]. Feb 2000;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. Jul 2002;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. Sep 1999;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. Oct 2008;27(5):216-21. [Medline].
Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical treatment of skier's thumb injuries: case report and review of the literature. Mt Sinai J Med. Sep 2006;73(5):818-21. [Medline]. [Full Text].
Ahn JM, Sartoris DJ, Kang HS, et al. Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers. Radiology. Mar 1998;206(3):737-44. [Medline].
Badia A. Arthroscopic reduction and internal fixation of bony gamekeeper's thumb. Orthopedics. Aug 2006;29(8):675-8. [Medline].
Bekler H, Gokce A, Beyzadeoglu T. Avulsion fractures from the base of phalanges of the fingers. Tech Hand Up Extrem Surg. Sep 2006;10(3):157-61. [Medline].
Hintermann B, Holzach PJ, Schütz M, Matter P. Skier's thumb--the significance of bony injuries. Am J Sports Med. Nov-Dec 1993;21(6):800-4. [Medline].
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. Mar-Apr 1997;15(2):193-6. [Medline].
O'Callaghan BI, Kohut G, Hoogewoud HM. Gamekeeper thumb: identification of the Stener lesion with US. Radiology. Aug 1994;192(2):477-80. [Medline].
Further Reading
Clinical Trials
- CMC (Carpometacarpal) OA (Osteoarthritis) Thumb Splint Study
- Prolotherapy Versus Steroids for Thumb Carpo-Metacarpal Joint Arthritis
- Return to Work After Hand Injury: the Role of Medical, Demographic and Psycho-Social Factors
National Guidelines Clearinghouse
- ACR Appropriateness Criteria® acute hand and wrist trauma. American College of Radiology - Medical Specialty Society. 1998 (revised 2005). 8 pages. [NGC Update Pending] NGC:004607
Keywords
skier's thumb, gamekeeper's thumb, thumb pain, broken thumb, break dancer's thumb, injury to the ulnar collateral ligament of the first metacarpophalangeal joint, UCL injury
Follow-up: Skier's Thumb