Ski Thumb - Injury To The Inner Collateral Ligament Of The Thumb

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-05-24 12:25

Ski thumb

The inner collateral ligament of the thumb, also called the ulnar collateral ligament, provides stability when holding and grasping. It connects the metacarpal bone of the thumb with the metacarpophalangeal joint of the thumb. Sudden, violent splaying of the thumb can cause the collateral ligament to overstretch. Often the cause is a fall or hit on the bent thumb. The injury often happens while skiing and is therefore also known as the “skier's thumb”.

However, the risk of injuring the collateral ligament is also high in other sports, such as ball sports or martial arts. Falls on the splayed thumb can not only happen during sport, but also in everyday life. This injury rarely occurs as a result of chronic overloading of the metatarsophalangeal joint.

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What types of injury are there?

The following injuries to the inner collateral ligament of the thumb can occur after overstretching or overloading:

• Strain of the ligament,
• partial tear (rupture) of the ligament,
• complete tear of the tape or
• Tear of the ligament from the bone.

What are the symptoms?

Shortly after the accident, the affected area of the thumb swells. There is severe pain in the thumb and tenderness on the inside of the thumb in the area of the metacarpophalangeal joint. Holding objects and moving the thumb cause severe pain or are not possible.

The normal stability of the thumb is no longer given. The thumb can be spread sideways more than usual. A bruise (hematoma) may form. If the ligament injury is left untreated for a long time, the thumb becomes more unstable and weaker.

What can those affected do themselves?

Immediately after the accident, the thumb should be cooled and immobilized if possible. If there are symptoms of a possible torn ligament, medical care is indicated.

How is the diagnosis made?

First, the doctor collects the medical history and the circumstances of the accident and asks about complaints:

• Where exactly does pain occur?
• Are there any mobility restrictions?
• Have there been previous injuries to the thumb?

This is followed by the clinical examination of the thumb. The doctor determines which symptoms are present, e.g. swelling, bruises, painful areas, etc., and checks the stability of the joint and the elasticity of the ligament. This examination of the thumb function is usually painful in the case of an acute injury. Therefore, the doctor can offer local pain treatment.

X-rays of the thumb will help the doctor diagnose the ligament injury. For a more detailed clarification, so-called functional recordings are sometimes made in an angled position using x-rays. Alternatively, ultrasound images of the moving thumb can show damage to the ligament or joint. Magnetic resonance imaging (MRI) can be used to clarify the need for an operation, especially if a Stener lesion is suspected.

How is a ligament injury treated on the thumb?

Depending on the type of injury, medical treatment is carried out with conservative therapeutic measures or surgery.

Conservative (non-surgical) treatment

Conservative treatment is usually carried out in the event of a strain and a partial tear in the ligament, but also in the case of a complete tear if the torn ligament is not displaced too much. The thumb is immobilized with a splint (thumb orthosis) made of plastic or plaster of paris for about six weeks. After about three weeks, the doctor can prescribe light exercise therapy from the splint in order to slowly restore the mobility and strength of the thumb. The doctor checks the success of the treatment. If there is no improvement after conservative treatment, an operation may be necessary.

surgery

With conservative treatment of a complete tear, there is a risk that a so-called Stener lesion will be overlooked. The torn collateral ligament slips under the surrounding tendon plate and can therefore no longer grow on the bone. A Stener lesion must be treated surgically.

However, an operation may also be indicated under other conditions, e.g. in the case of a bony tear and a clearly slipped piece of bone or a complete tear in the ligament if the imaging diagnosis shows a greater displacement of the ligament (more than two millimeters). The operation is done through a small incision on the inside of the thumb. The torn tape is fixed with seams, wire anchors, etc. After the operation, the thumb is immobilized with a plastic splint or plaster of paris for about five weeks. The subsequent exercise therapy is important in order to restore the mobility of the thumb and to avoid tendon adhesions.

The results of surgical treatment are generally good and complications are rare.

Whom can I ask?

The diagnosis and treatment of an acute injury to the ulnar collateral ligament is usually carried out in a hospital or in an outpatient clinic by specialists from the following specialties:

• Orthopedics and Traumatology
• Orthopedics and Orthopedic Surgery
• Trauma surgery
• Specialists in hand surgery

An inpatient stay is necessary for surgical treatment.

For clarification of non-acute, chronic complaints of the metatarsophalangeal joint, you can contact the responsible resident specialists.

The exercise therapy after acute treatment can be performed on an outpatient basis by a doctor, for example, in the Outpatient Department or by established physiotherapists / physical therapists or occupational therapists / occupational therapists.

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. For more information, see What does a hospital stay and a doctor's visit cost: costs and deductibles.

Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “cash prescription”. For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.