The incidence of hand injuries varies considerably among skiers and snowboarders. In a study of 7,430 snowboarding-related injuries, Idzikowski et al noted that hand injuries accounted for 8.4% of upper extremity injuries. Of the hand injuries, 50% were fractures, 31.5% were sprains, and 5.6% were dislocations. Ulnar collateral ligament (UCL) injuries accounted for only 1.8% of reported hand injuries among snowboarders. In contrast, UCL injuries are among the most common skiing injuries. Van Dommelen and Zvirbulis found that UCL injuries accounted for up to 80% of all upper extremity injuries in skiers.
Watson-Jones initially studied the UCL and its effect on thumb stability in 1943. Campbell first reported chronic laxity of the UCL in gamekeepers, a condition that later was termed gamekeeper's thumb. Frequently encountered in skiing, acute traumatic rupture of the UCL popularized the term skier's thumb to describe this injury (Figure 1). The typical mechanism of injury involves a fall while the skier holds a ski pole or when a skier continues forward while the pole is planted firmly, resulting in forced thumb metacarpophalangeal abduction and extension.[28,29]
Illustration showing the mechanism of thumb metacarpophalangeal ulnar collateral ligament injury, known as skier's thumb. (Copyright Rick Sargent, Sargent Illustration and Design.)
J Am Acad Orthop Surg. 2018;26(1):e1-e10. © 2018 American Academy of Orthopaedic Surgeons