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Published on February 01, 2016

Skier’s thumb can happen on or off the slopesSkier’s thumb can happen on or off the slopes

The first time Katrina Manni suffered “skier’s thumb,” she was playing softball.

“I caught a ball and it landed on my thumb,” she said.

The accident hyper-extended her left thumb, breaking the ulnar collateral ligament on the inner side of the middle joint of the thumb. This is where the hand connects the thumb to base of the index finger. The ligament ties the thumb’s middle bone, or proximal phalanage, to the metacarpal in the ball of the thumb.

According to the Academy of Orthopaedic Surgeons website, skier’s thumb weakens your ability to pinch and grasp.

Manni said she was initially told her thumb was just bruised, so she didn’t get it looked at by an orthopedic surgeon until a year later. Because she had severed the ligament, and had gone so long before getting help, the surgeon was unable to reattach the broken ligament and fashioned a new one from a tendon in her wrist.

She later fell and partially tore the same ligament on her right thumb.

Manni, 21, now of Athens, Vermont, but formerly of Osterville, said the injuries made it hard to do her job at a local fish market.

“Holding pans and trying to pick things up were difficult because of the pain,” she said.

Her second injury was repaired by Brian Najarian, MD, who specializes in hand surgery at Cape Cod Hospital and has offices in Hyannis and Sandwich. He removed some scar tissue and tightened the stretched ligament before placing her thumb in a splint-like cast for three months, which was followed by physical therapy twice weekly. Dr. Najarian told her the surgery was optional, but not having it done would increase her chances of both developing arthritis in the joint and needing to have the joint operated on sometime in the future.

“Now, I’m awesome,” Manni said. “The physical therapist got me back to where I wanted to be in about three months.”

Skier’s thumb, also known as “gamekeeper’s thumb,” gets its name from skiers hyper-extending their thumbs when they fall, usually while holding a ski pole.

“I see it a few times a month,” Dr. Najarian said. “It’s common in athletes; can happen in any sport.”

Dr. Najarian divided these cases into sprains, in which the ligament is partially torn and stretched, and complete ruptures, in which the ligament is severed, often tearing off a small bit of bone.

Treatment for a sprain consists of immobilizing the joint in a cast for four weeks, then partial movement is allowed for another few weeks. A complete rupture requires surgery to either reattach the ligament to the bone or to replace the ligament with a tendon from the forearm. The repaired joint is then placed in a cast. Treatment soon after injury provides better results, Dr. Najarian said.

He described a patient who went 10-15 years before getting treatment.

“You can develop arthritis” in such cases, he said. “We usually end up doing a joint fusion.”

However, most patients do seek treatment early, he added.

“They fell on their hand and they’re complaining of pain and swelling on the inside of that joint.”

The injury can be diagnosed by moving the thumb. If it moves outward beyond the point where it normally should stop, the ligament is probably torn, Dr. Najarian said. An X-ray, MRI or ultrasound may be ordered to determine the extent of the injury.

“It’s a year-round injury,” Dr. Najarian said. “It can be from a fall in the winter or activities in the summer.”