Skiing falls can often cause injury to the inner ligament of your thumb, caused by the force of the pole against this area of the hand during a fall. This area, a band of fibrous tissue connecting the bones at the bottom of the thumb, is known as the ulnar collateral ligament.
This injury is essentially the same as what clinicians have traditionally called gamekeeper’s thumb. The actual injury is a sprain of the ulnar collateral ligament (tearing of ligament). So whether it’s called skier’s or gamekeeper’s thumb , we are referring to the same injured structure.
Skier’s thumb is an acute, or one-time, injury of the ulnar collateral ligament that occurs when you fall during skiing, and your hand remains caught in the ski pole. The fall in this instance can cause stress on the ligament, resulting in the “sprain,” while gamekeeper’s thumb actually refers to a pattern of injury over time that causes a loosening of the ulnar collateral ligament. The term “gamekeeper’s thumb” comes from Scottish gamekeepers who would break the neck of wounded rabbits by holding them between the ground and their thumb and index finger. Over time, the inner ligament of the gamekeeper’s thumb would become sprained, resulting in injury.
Treatment options for both skier’s thumb and gamekeeper’s thumb are fairly similar. Typically a physician will evaluate the severity of the sprain and frequently will initiate a treatment program with immobilization. While immobilized in a cast or splint, you are allowed to stay active but are not allowed to apply stress to the healing ligament. This cast or splint is maintained for four to six weeks, at which time we begin a progressive program of motion and strengthening to allow your complete recovery. If the injury is more severe or if there is a complete tear of the ligament, surgery may also be considered. Either way, it is best to return to normal use of the area only after completing gentle motion exercises for a while to rebuild the strength of the ligament. If you have been diagnosed with skier’s thumb or gamekeeper’s thumb, talk to us about treatment and exercise options.