Hand Surgery

Skiers Thumb (ulnar collateral injury)

Picture of thumbThe ulnar collateral ligament (UCL) is at the base of the thumb near the web of the thumb. A ligament is a tough fibrous band that holds two bones together. The ulnar collateral ligament stabilises the joint at the base of the thumb when it pinches against the index finger (for example turning a key).

The UCL can be torn or rupture if the thumb is forced sideways from the hand. This injury may occur in many situations, but is particularly common in skiers; during a fall, the ski pole can be responsible.

Diagram of skiers thumbThe diagnosis is made from the history of the injury and examination of the thumb. An X-ray is required to determine whether or not there is an associated fracture of the bone where the ligament attaches. In some cases an ultrasound scan is necessary to demonstrate if the ligament has be partly torn or has ruptured completely.

Skiers thumb trestmentTreatment depends on whether the ligament is partly torn or has ruptured completely, and also if there is an associated fracture.

A partial tear (sprain) of the ligament is treated using a custom made light-weight plastic splint, made by my hand therapist and a hand therapy programme to ensure recovery in the shortest time. Ligaments are slow to heal and the splint is required for about 6 weeks in most cases.

Cases where the ligament has ruptured, or has pulled off a piece of bone at its attachment require surgical repair. Surgery is performed under general anaesthetic as day surgery. The surgical procedure involves either repair of the ligament using sutures or reattachment of the ligament to the bone using a small titanium pin called a bone anchor. In some cases where there is a large fragment of bone, this is secured using mini titanium screws. I use a 'minimal access' approach, using a very small incision; this has the advantage of little scarring and reduces the likelihood of joint stiffness.

Following surgery a custom made plastic splint is used and hand therapy programme started.

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