SKIERS THUMB - TREATMENT, PREVENTION AND RECOMMENDATIONS

Skier's thumb is an injury to the ulnar collateral ligament (UCL) of t he thumb metacarpophalangeal joint (MCPJ) which has a serious risk of disabling chronic instability if not treated adequately. The lesion mo st often occurs in skiers when the ski pole forces the thumb to deviat e radially. Strapless poles do not decrease the incidence of skier's t humb, but if skiers are trained to discard the pole during a fall the risk might be reduced. Clinical and anatomical findings and the unders tanding of the injury mechanism show that stability testing (performed with the joint in full flexion) and additional standard radiographs r emain the keystones in decision making in all MCPJ sprains. Protective splinting is advocated in stable, undisplaced avulsion fractures and incomplete ligamentous lesions of the UCL. However, surgery should not be delayed where there are displaced bony avulsion fractures, and whe re a complete ligamentous rupture is suspected because of a more than 30-degrees stressed radial deviation and more than 20-degrees differen ce compared with the uninjured side. Controlled active range of motion exercises can usually be started 3 to 4 weeks after the injury or ope n surgical repair, respectively. Protective splinting is continued unt il the sixth week and unrestricted use allowed 12 weeks following inju ry.