Orthopedics-Online

Ski thumb

definition

At the Ski thumb it is usually a painful one Ligament injury. This usually leads to a complete rupture of the collateral ligament (med. Ulnar ligament or ulnar collateral ligament) at the thumb joint. The tape can tear in different places. There are three medical locations:

either in the middle (med. interligamentary)
close to the base (this refers to the end of the band towards the wrist)
or distal (this means the direction of the thumb).

In some cases, the ligament injury can be combined with a bony fragment (med. Bony tear).

Occasionally there is only a sprain with a torn ligament or a stretch.

Synonyms

Ligament injury at the metatarsophalangeal joint
Rupture of the ulnar collateral ligament
Rupture of the ulnar collateral ligament
thumb Pain

root cause

The cause is often a forceful splaying (radial duction in the metacarpophalangeal joint) of the thumb. This can occur as a result of a fall while skiing or through various other sports.

The most common causes include falls while skiing, e.g. by getting the thumb caught in the loop of the ski pole. But also impact injuries in ball sports can often lead to this injury.

Do you have specific thumb pain?

This article might also interest you: Overstretched thumb

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

Lumedis - orthopedic surgeons
Kaiserstrasse 14
60311 Frankfurt am Main

You can make an appointment here.
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For more information about myself, see Lumedis - Orthopedists.

anatomy

The Thumb ligament (ulnar collateral ligament) runs on the inside of the thumb, i.e. from a medical point of view on the little finger side of the thumb.
For those interested in medicine, the ulnar collateral ligament runs down from the dorsoulnar side of the metacarpal head and attaches to the ulnar side at the base of the proximal phalanx.

The Ulnar collateral ligament serves to stabilize the metacarpophalangeal joint of the thumb and is a prerequisite for enabling fine movements such as holding objects or firm gripping.

Symptoms and Diagnosis

The injury can often be felt or heard by a crack in the thumb in the accident. A short time later there is both a significant swelling with a bruise (hematoma) and a swelling in the area of the metacarpophalangeal joint
In addition, there is an increased foldability (sign of instability) of the metatarsophalangeal joint, which can be ascertained during the clinical examination, since there is no stabilization by the ligament. In addition, there is a painful limitation of the grip function.

Due to the pain that occurs after the accident, a diagnosis cannot always be made with a clinical examination. Therefore, a new examination should be carried out after immobilization.
For this purpose, a side comparison is recommended to check the movement, as there is a large variance in the mobility of the metacarpophalangeal joint. To rule out a bony avulsion, an x-ray of the thumb must be taken, and if necessary, images must be taken to compare the sides.

After a few days, symptoms may appear to improve even without treatment. Nevertheless, it is strongly advised to consult an orthopedic specialist.

If the skier's thumb is left untreated, the constant rubbing on the articular cartilage leads to wear and tear on the base of the thumb (joint arthrosis). The pain that may develop as a result can lead to the metatarsophalangeal joint stiffening and misalignments that may develop persist.

Here are other possible causes for

Pain in the metatarsophalangeal joint.
Saddle joint pain

Clinical classification

There are four stages in the skier's thumb:

sprain with smaller fiber tears in the tape. One also speaks of one Distortion
Complete ligament tear (ligament rupture)
Bony ligament tear
Dislocation (dislocation) in the thumb joint

complication

In one form of the Ski thumb Part of the remainder of the ligament can hit the edge of a tendon plate (tendon aponeurosis of the adductor pollicis muscle). One speaks here of the so-called Sterner's lesion. With this type of injury, anatomical healing is no longer possible, as the remnants of the ligament can no longer approach. The result is the emergence of a chronic instability.

therapy

A fundamental distinction is made between the therapy acute injury of the therapy chronic instability.
In the acute injuryg there is the option to proceed conservatively or operatively. There are no reliable diagnostic features for deciding which treatment option to choose. In general, when the joint is slightly flexed, an opening of 35 ° is an indication for surgery.
Based on clinical experience, hardly a skier's thumb needs to be treated surgically.

If the conservative approach is chosen, the thumb is immobilized in a thumb and forearm cast for 3 weeks. Careful mobilization begins after 3 weeks. After two more weeks you steadily increase the load. After 10-12 weeks, the thumb should be able to bear full load again. Alternatively, the injury can be immobilized in a tape bandage or a thumb splint.
The thumb splint, in most cases, is that of Dr. Nicolas Gumpert preferred method of therapy.

If the indication for an operation is made, different procedures are available depending on the type of tear. On the one hand, the ends of the tape can be sewn, but supply via a special wire seam is also possible. If there is a bony tear, it is reattached with special wires.

After the operation, the thumb is immobilized for 6 weeks. After this time the physiotherapy exercise treatment to restore normal joint function.

Is there a chronic instability before, a ligament is usually performed. The palmaris longus tendon is often used for this. If there is still instability in the joint or if post-traumatic osteoarthritis develops (osteoarthritis as a consequence of an accident), the metatarsophalangeal joint is stiffened, since stability is crucial for the good function of the joint.