eMedicine Specialties > Sports Medicine > Wrist and Hand

Skier's Thumb: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Jonathan Raanan, MD, Assistant Professor of Physical Medicine and Rehabilitation, Department of Neurosurgery, Stony Brook University Medical Center; Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine; Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital
Contributor Information and Disclosures

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.
 
Acknowledgments

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

References

  1. Connolly JF. Dislocations of the thumb and fingers. Fractures and Dislocations - Closed Management. Vol 2. Philadelphia, Pa: WB Saunders Co; 1995:1508-9.

  2. Nicholas JA, Hershman EB. The Upper Extremity in Sports Medicine. St. Louis, Mo: Mosby; 1995:557-64, 598-9, 873.

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

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

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

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

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. Badia A. Arthroscopic reduction and internal fixation of bony gamekeeper's thumb. Orthopedics. Aug 2006;29(8):675-8. [Medline].

  17. 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].

  18. 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].

  19. 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].

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

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

Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

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 and 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, UMDNJ-New Jersey School of Medicine
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, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital
Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, 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
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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