Skier's Thumb "Gamekeeper's Thumb"
Skiers Thumb is also referred to as Gamekeeper's Thumb. It is caused by a forced abduction of the thumb from either falling or when the Metacarpal Phalangeal joint is forced in a direction till the lulnar collateral ligament fails.
The original name came from the injury seen in the medieval times when it was up to the gamekeeper to break the necks of the pheasant or other game to be prepared for meals. The action forces the thumb away from the hand and either breaks the bone or tears the ulnar collateral ligament off the bone.
The same mechanism can be seen when a skier’s pole if twisted out of his hand while falling.
Treatment depends on whether the bone has been broken or not.
If the bone is not broken, then simple immobilization in a splint or cast can work well if it is protected for a minimum of 6 weeks. At the Thumb Specialty Center, a series of patients with this injury were immobilized without surgery, and 95% of the patients healed without surgery. This will only fail if the ligament has been pulled out of position and can't reattach.
Today's technology allows us to examine the joint and detect the condition where the ligament has been pulled out of its native position. This is called the Stenner's lesion. The extensor mechanism prevents the ligament from re-attaching to the bone. These patients require surgery to move the extensor hood out of the way to allow the ligament to be placed back into position. Usually a form of fixation is also performed to attach the ligament back to the bone.
If the ligament has avulsed a piece of bone from the thumb, it is easily detected by standard x-rays .This must be re-attached surgically. If much delay takes place before surgery, then the ligament can shorten severely, to the point that it cannot be attached.
If the Skier's Thumb injury is more than 6 weeks old, it is the Thumb Specialty Center's recommendation that the ligament should be reconstructed with a tendon graft. This involves harvesting a tendon from another area or use of banked tendon material from another person. Banked tendons are treated according to strict Federal regulations to assure safety against the transmission of diseases that the donating patient may have had. After reconstruction the joint must still be protected for up to 8 weeks.