A 32-year-old male presents to the emergency department with right thumb pain after a skiing accident. He fell and landed on his outstretched right hand, pulling his right thumb away from his ski pole. On examination, swelling and tenderness were found over the right thumb. An avulsion of the ulnar collateral ligament, also known as skier's thumb, was diagnosed. Treatment involved splinting the thumb and following up urgently with hand surgery.

2.  CC: R thumb pain
 HPI: 32 yo right-handed male
presents to the ED s/p skiing
accident complaining of R thumb
pain. Patient admits to losing his
balance on the slopes one hour
ago, he was holding onto his ski
pole tightly when he landed on his
R hand. He admits that his R
thumb was pulled away from the
ski pole during the fall. He
complains of R thumb pain since
fall. He admits to swelling in the
area and has had a difficulty time
untying his skis since the event.
He denies any other injuries or
LOC.
VS: T: 97.1 P: 78 R: 18 BP:
140/84 O2: 95%RA
Musculoskeletal: RUE:
2+radial pulse. Ecchymosis
over thenar eminence and
TTP about 1st digit MCP.
Decreased pincer grasp
noted. Flexion/extension
intact about thumb PIP.
Otherwise normal
motor/sensory function

4. Avulsion of UCL (ulnar collateral ligament) of the thumb
Also known as Skier’s thumb

5.  Thumb spica splint placement and urgent hand
surgery follow-up (the patient who suffers an acute
UCL injury is more likely to undergo and respond to
UCL surgical repair)
 Pain Control

6.  6 different Classifications of UCL avulsions, based on
stability
 Stener Lesion –dislocation of the torn end of the
ligament dorsally above the adductor
aponeurosis/adductor pollicis muscle such that it is
separated from the joint –indication for surgical repair
 Acute tears (skier’s thumb) have better prognosis than
chronic (gamekeepers)

7. 
type I



type II



no fracture but unstable
requires surgery
type V



no fracture present and the joint is stable in flexion
typically treated with a splint / cast
type IV



displaced fracture present
requires surgery
type III



fracture present, which is non-displaced & stable in flexion
typically treated with a splint / cast
fracture present, involving the volar plate, but stable in flexion
typically treated with a splint / cast
type VI


fracture present, involving the volar plate; unstable
requires surgery

8.  Type 1 Skier’s Thumb

9. Koval, K. et al. Handbook of Fractures. 4th Edition. 2010.
Northwestern University School of Medicine: Emergency
Medicine Residency Orthopedic Teaching Files
http://www.feinberg.northwestern.edu/emergencymed/res
idency/ortho-teaching/
Wheeles Ortho online
textbook http://www.wheelessonline.com/
http://radiopaedia.org/articles/gamekeepers-thumb