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Skier's / Gamekeeper's Thumb
Definition: Skier's thumb is a tear or avulsion of the ulnar collateral ligament of the thumb at its insertion site about the proximal phalynx. Skier's thumb is differentiated from Gamekeeper's thumb in that the former refers to an acute injury, whereas the latter refers to a repetitive, chronic injury.
Causes: A common cause of Skier's thumb is a fall on an outstretched hand. Extension and hyperabduction at the thumb introduces a valgus force on the metacarpophalyngeal (MCP) joint of the thumb. The term Skier's thumb originates from the fact that skiers often presented with this complaint after falling against a fixed ski pole.
Gamekeeper's thumb, which refers to the same pathology but of a different aetiology refers to the gamekeeper's who used sustain injuries on the medial collateral ligament of the thumb due to the manner in which they slaughtered their animals. The movement of wringing the animal necks placed repeated amounts of stress upon the medial collateral ligament of the thumb.
Examination: Patients suffering from Skier's thumb or Gamekeeper's thumb will present with some instability at the MCP joint along with pain in the ulnar portion of the thumb and diminished pinch grasp. The symptoms will vary in intensity depending of the severity of the sprain and the time of onset since the visit. Acute presentations will usually be oedematous with some ecchymoses. A weak thumb grasp is often pathoneumonic.