Skier's Thumb

"Stellar to none in his surgical skills"

“Dr. Julka is stellar to none in his surgical skills and patient management. He not only has the skills and knowledge of a surgeon, but the bedside manner of a friend. He included myself and family in each decision process to ensure all would be aware. I would not hesitate to recommend him to family and friends should their need arise...”

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Skier's/Gamekeeper's Thumb

What is a skier's thumb injury?

Skier’s thumb is the common name used for an injury to the thumb that causes detachment or tearing of the ulnar collateral ligament of the thumb 

What is the function of the ulnar collateral ligament?

Your thumb metacarpal phalangeal (MCP) joint (the knuckle of the thumb) has two primary ligaments. On the side closest to the index or pointer finger is the ulnar collateral ligament which attaches the two bones that make up the joint and allow for its stability.  As the ligament tears it can result in a unstable thumb that cannot resist the normal forces placed on it with every day activities.  Functionally this means patients have continued pain and inability to use their thumb for even simple tasks such as writing, pinching to open a bottle top and may even demonstrate a thumb deformity.   

How is skier's thumb diagnosed?

In the hands of an experienced hand surgeon skier’s thumb can be diagnosed with a simple Xray and detailed examination.  Although we often see patients who have already had an Ultrasound or MRI for their thumb we do not feel additional testing is necessary in most situations. 

Do I need an MRI?

You do not require an MRI to demonstrate and treat a skier’s thumb injury.  In most patients the pathology is very evident on Xray and examination alone. 

How is skier's thumb treated?

Skier’s thumb is treated based on the degree of injury. In cases of very mild injury we treat the injury with a protective custom made brace to protect your ligament while allowing you to live life.   In cases of severe injury where the entire ligament has torn off of the bone surgery is required to prevent future instability and issues.  

What is the surgery for skier's thumb?

Surgery for skier’s thumb is performed in an outpatient setting and typically takes about 45 minutes.  The surgery is performed with local anesthesia placed at the site of surgery or higher up closer to the shoulder to numb the arm as well as some mild sedation for comfort. The procedure begins by making a small incision over the ligament and locating the torn edge of the ligament. We then place a device into the bone that anchors a strong suture/stitch into the bone and  allows us to attach the ligament directly to the bone.  After surgery your wound is closed with sutures under the skin and glue. 

Will I need a cast after surgery?

Our protocol differs significantly from many others. We do not place patients in cast after skier’s thumb repair. We do place you in a splint or half cast after surgery for 3-5 days. At 3-5 days your splint is removed and a custom made plastic removable splint is applied. We allow you to remove this splint to shower and for self care.  We have found the ability to shower, get ice to your hand, and simply live life without a cast for 6 weeks is very important to the recovery of our patients. 

Do I need general anesthesia for CMC arthroplasty?

The vast majority of our skier’s thumb repair surgeries are performed with numbing of the entire arm as well as some mild sedation as you might receive during a colonoscopy. General anesthesia is done in some instances and this is based on patient and anesthesia physician preference. 

Do I have to stay overnight in the hospital?

All of our  skier’s thumb surgeries are performed in a surgery center on an outpatient basis. 

What can I do after my surgery?

You will be placed in a small splint to immobilize your thumb. This will be removed by Dr. Julka 3-7 days after surgery and you will be given a removable splint.  You will start some gentle home exercises and be allowed to shower over the incision at this stage.  The removable splint is typically worn for around for 6 weeks. While we allow you to move your thumb gently we do not allow thumb use with any pinching or gripping for 8-10 weeks. 

When can I get back to my normal activities?

We allow you to start exercising while maintaining restrictions on your thumb at 2 weeks after surgery.  We restrict vigorous cardiovascular exercise for the first 4 weeks as this can lead to increased swelling. We do restrict you from any pinching activities till your ligament is fully healed, around 10 weeks. 

How do I know if I need to seek treatment?

We see many patients on a daily basis that tell us they wished they would have sought out treatment sooner. Generally, treatment for skier’s thumb is much more effective when started early.   Dr. Julka and the hand surgery team is here to help.  If you have had a thumb injury and are worried about a skier’s thumb or thumb UCL ligament tear please contact us for an evaluation.