Skier's (Gamekeeper's) Thumb

Overview

what it is and why it matters

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves. — **Hand and wrist anatomy.** Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.

Skier's thumb is an acute injury to the ulnar collateral ligament (UCL) of the thumb MCP joint, classically occurring when a ski pole forces the thumb into radial deviation on a fall. Gamekeeper's thumb refers to the chronic attritional form historically seen in game wardens. The UCL stabilizes the thumb against lateral stress during pinching and gripping — when it tears completely, the joint becomes unstable and pinch strength is severely reduced.

A Stener lesion occurs when the avulsed ligament end is displaced outside the adductor aponeurosis, preventing spontaneous healing — this is the key reason many complete tears require surgery.

Diagnosis

exam first, imaging second

Radial stress testing of the MCP joint in 30° of flexion reveals laxity. Valgus opening >35° or >15° greater than the opposite side indicates complete rupture. Stress X-rays confirm and MRI can identify a Stener lesion before surgery.

Treatment Path

how care progresses at OSI

Thumb spica cast / splint

For partial (grade I–II) UCL tears: 4 weeks of immobilization allows ligament healing.

Surgical Options at OSI

if non-operative care isn't enough

Complete UCL tears and all Stener lesions require surgical repair. A Stener lesion cannot heal on its own.

Overview

Diagnosis

Treatment Path

Thumb spica cast / splint

Surgical Options at OSI

Providers Who Treat Skier's (gamekeeper's) Thumb

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Further Reading

Find your surgeon

Find your location