Ulnar collateral ligament (UCL), commonly known as Skier's thumb due to its high prevalence in skiers who fall whilst holding on to their ski-poles, is an ever-increasing sports related injury to the thumb.
This type of injury is something that ISEH’s Orthopaedic Surgeon, Mr Jae Rhee, commonly sees this time of year, treating both elite athletes and keen skiers at our leading sports, exercise and medicine facility in Central London.
To learn more about this type of injury, we spoke with Mr Jae Rhee who shares important and helpful advice to help people be better informed.
Mr Rhee shares tips on how to prevent this type of injury, explains when to seek medical help, and shares key insight into how the condition is diagnosed and what to expect during a consultation. He also discusses the treatment options and tips to aid recovery.
How common is an ulnar collateral ligament injury? (known as Skier’s thumb)
Ulnar collateral ligament (UCL) injury accounts for 80% of all thumb injuries – so this is a common injury. It makes up 35% of all ski-related injuries.
There are an estimated 200,00 UCL/Skier’s Thumb injuries per year in the US alone.
Skier's thumb is not exclusive to skiing; it can happen in any circumstances that involve falling on an outstretched hand, causing hyper-abduction and valgus stress on the thumb Metacarpophalangeal joint (MCPJ). This can happen in any sports usually involving sticks (e.g., Hockey) or ball sports like netball/basketball, or occur from a bicycle/motorcycle as a result of the thumb getting stuck behind the handlebars.
Do you have any tips to prevent this type of injury when skiing?
UCL injury occurs in skiers when they fall holding on to their ski pole, causing extreme bending and stress on the thumb at the Metacarpal phalangeal joint. Despite renewed and improved designs in ski-poles, it unfortunately remains a common injury.
The most important advice that Mr Jae Rhee can offer skiers, to help avoid this type of injury:
1. Never use the strap on the ski-pole - it is better to lose the pole and retrieve than to fall whilst holding on to the pole.
2. Make a conscious effort to let go of the pole when falling. Not placing your hands through the straps will help.
3. Try to avoid placing your hands down on the snow to break your fall.
When should someone seek medical advice – can symptoms be managed at home?
Following an acute UCL injury, there will be pain and swelling on the inside of the thumb. It is advisable that patients seek medical attention, as an x-ray would be advisable in the first instance to rule out an associated fracture.
In the absence of a fracture, the thumb must be splinted/braced and rested. You may be provided a removal splint or placed into a specific thumb-spica plaster cast.
In all cases, the initial management would be to splint, rest, ice and elevate to manage the acute symptoms. Following this, I would strongly suggest a consultation with an upper-limb specialist.
What can a patient expect during a consultation?
During a consultation, Mr Jae Rhee will discuss the exact mechanism of injury and examine your thumb.
Diagnosis of UCL/Skier's thumb can be determined from examining your thumb, stressing the ligament to demonstrate instability. This will be done to both your thumbs for comparison to the normal side, as every individual will have a variable degree of laxity in their joints.
Following this, if a patient has not already had one, an x-ray of your thumb will be arranged to exclude an associated fracture. Ultimately, a scan (MRI) will be required to confirm diagnosis and determine the integrity of the ligament. MRI scans are highly sensitive with sensitivity of 96-100% and specificity of 95-100%, and will help determine partial or complete injuries to the UCL.
What happens during a ulnar collateral ligament thumb test?
During examination, your thumb will be tested to check the integrity of the UCL. An ulnar collateral ligament thumb test is a stress test, where the examiner will be stretching the thumb side-ways to stress the ligament. Both thumbs will be tested during the examination for comparison.
A positive test is when the thumb metacarpophalangeal (MCP) joint is more lax than the normal side.
How best to treat Skier's thumb injury/ how is it diagnosed?
UCL/Skier’s thumb can be treated non-surgically in a thumb splint or spica cast or surgically with an operation to repair and reconstruct the ligament.
Following clinical testing and MRI scan, your specialist will be able to advise the severity of the UCL injury.
Partial injuries can be treated conservatively and requires immobilisation in a brace or cast. Immobilisation for 4-6 weeks is recommeneded (depending on clinical testing), followed by physiotherapy of the hand for a further period of 6 weeks before return to full grip/activities.
Complete ruptures, however, would require surgical repair/reconstruction. Surgery is performed as a day-case under regional anaesthesia. Mr Rhee would strongly recommended undergoing surgical repair within 4 weeks from the injury.
Following surgery, a period of 6 weeks immobilisation is required, followed by physiotherapy of the hand for a further 6 weeks before a return to full grip/activities.
Are there any exercises you would advise for people to do to aid recovery?
During the acute stage following injury or immediately after surgery, you are advised to elevate the injured limb, applying ice (never directly to skin), splint or cast and painkillers including paracetamol and NSAIDs if tolerated. As swelling subsides, moving the other digits in the affected hand is recommended to prevent stiffness.
During this time, general cardio-respiratory exercise and core exercise will help in general well-being and encourage tissue health.
Your physiotherapist will advise appropriately.
Make an appointment:
Mr Jae Rhee, is a leading Consultant Orthopaedic Surgeon who has vast experience managing both athletes and the general population for shoulder and upper limb injuries. His areas of expertise include diagnosing and treating sports related injuries to the shoulder, wrist and hand, and performing novel techniques in rotator cuff injuries and arthroscopic (keyhole) surgery for acromio-clavicular injuries.
To enquire about a private appointment at our conveniently located facility in Central London, please contact our team by calling +44 (0)20 3447 2800 or by emailing info@iseh.co.uk.