# Skier's thumb Skier's thumb is a sprain or tear of the ligament at the base of the thumb, on the index-finger side (the ulnar collateral ligament). A fall levers the thumb outward, against a ski pole grip or the snow. A partial tear is treated in a splint; a complete tear may need surgery. We assess the thumb, fit a heat-moulded splint, and rebuild pinch and grip in stages. ## Symptoms - Pain and swelling at the base of the thumb after a fall - Bruising in the web between the thumb and index finger - Pain or weakness when you pinch, such as turning a key - A thumb that feels loose or wobbly when you grip - A weak hold on a ski pole, a handlebar or a door handle - Tenderness when you press on the inside of the thumb base - A small lump near the base of the thumb ## Assessment We start with how it happened: a fall with a pole in your hand, a crash in the bike park, or a ball that bent the thumb back. Then we check swelling and bruising, and press along the thumb base to find where it is tender. We test the ligament by gently pushing the thumb sideways, with the joint straight and then slightly bent, and compare it with your other thumb. We also measure pinch and grip strength and check the feeling in the thumb. If the joint opens further than the other side, or your thumb feels loose, see a doctor or nurse practitioner soon. They can arrange an X-ray or scan and, if needed, a surgeon's opinion. A ligament can tear a flake of bone away with it, and a complete tear where the torn end flips out of place often needs surgery. ## Treatment A partial tear heals with the joint held still. The splint is a sheet of plastic that turns soft in warm water (thermoplastic). We shape it on your hand to hold the thumb joint steady, and it goes rigid as it cools. We reshape it as the swelling settles. See [splints and bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing). Once the ligament can take it, rehab builds in stages: - **Movement:** gentle bending and straightening of the thumb, out of the splint, so the joints do not stiffen while the ligament is protected. - **Pinch and grip:** strength work that starts with a light pinch and builds to a firm grip, adding load as the joint stays steady. - **Everyday use:** keys, jars and zips, then the tool use your work asks of the hand. - **Stiffness:** hands-on treatment if the thumb or wrist joints tighten up in the splint. ### After surgery If the ligament is repaired, we follow your surgeon's plan: a splint to protect the repair, then movement, then strength, with the surgeon's timing counting alongside our testing. ### Hand therapy We offer [hand therapy](https://backinactionphysiotherapy.com/services/hand-therapy) through a Certified Hand Therapist, certified by the Hand Therapy Certification Commission, for thumbs that need close rehab, such as after surgery. It brings physiotherapy and occupational therapy together for the hand, wrist, elbow and shoulder. ## Getting back to sport You go back to work, study and sport when the thumb passes testing, not on a date. We compare it with your other thumb for pinch strength, grip strength and how steady the joint is under load. Before that, we practise what your sport asks of the thumb. For skiers, that is pole plants and holding on through a rough run. We also look at how you hold the pole, and whether to ski with the strap. For riders, it is braking and gripping the bar on long descents. ## When to come in Book an assessment if the base of your thumb is painful or swollen after a fall, or the thumb feels weak or loose when you pinch. Come in when a cast or splint comes off, and after surgery once your surgeon says therapy can start. An old skier's thumb that still feels weak on the pole is also worth an assessment. If the fall happened at work, your treatment can go through a WorkSafeBC claim. Go to the emergency department right away, or call 911, if any of these happen: - the thumb looks out of shape - your fingers are numb, cold or pale - a deep cut to the thumb or hand - worsening pain or numbness under a splint or cast ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Hand Therapy](https://backinactionphysiotherapy.com/services/hand-therapy) - [Splints and Bracing](https://backinactionphysiotherapy.com/services/splints-and-bracing) ## Frequently asked questions ### Do I need surgery for skier's thumb? Not always. A partial tear, where the ligament is stretched or torn only part way through, usually heals in a splint, with rehab after. A complete tear is different. If the torn end flips out of place, it cannot heal back onto the bone, and that often needs surgery. The decision rests with your doctor, nurse practitioner or surgeon, after an examination and, where needed, a scan. We test how steady the joint is and explain what we find. ### How long do I wear the splint? No set time. Early on you wear it most of the day and night, taking it off only as we advise, so the ligament heals at its proper length. As it heals and the joint tests steadier, you wear it less, then only for sport, heavy lifting or tool work. After surgery, your surgeon's plan sets the timing. ### Can I ski with skier's thumb? Not yet. A ligament that is still healing can tear further in the next fall, and a joint left loose can stay loose. The thumb goes back on the pole when pinch and grip pass our tests, and, after surgery, when your surgeon agrees. For the first runs back, a splint or tape under the glove can protect the joint. ### Should I ski with pole straps after skier's thumb? Worth thinking about. A strap keeps the grip in your hand as you fall, so the pole can lever the thumb outward again. Some skiers choose to ski without the strap. Others keep it and practise letting go of the pole as they fall. We go through your pole hold with you before you return, including how the grip sits in your palm. ### Is skier's thumb the same as gamekeeper's thumb? Almost. Both names refer to the same ligament at the base of the thumb. Gamekeeper's thumb is the older name, for a ligament stretched slowly by repeated strain. Skier's thumb is the sudden version, torn in a single fall. The two names are often used for either. The assessment is the same, and so is the aim of treatment: a joint that stays steady when you pinch. *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*