1) Skiers thumb
The joint between your first phalange and metacarpal bone is known as your metacarpal joint (MCP) (the thumb knuckle between your hand bone and first thumb bone).
There are two ligaments either side of this joint to secure the bones together- the radial and ulnar collateral ligaments.
Spraining the Ulnar ligament (which lies on the inside aspect/web space of the thumb) is one of the most common hand injuries in sport and is often known as skiers thumb. Injury occurs due to a fall onto an outstretched thumb were the thumb is hyper extended and abducted (move outwards) and is more likely when gripping sometime thing- which is why it is common in skiers falling holding ski poles. If the force is great enough to the ligament it will result in it been sprained or ruptured.
Signs and symptoms
Pain and tenderness over the MCP joint
Weakness and an inability to do gripping/pinching
Bruising and swelling
Loss of stability at the joint
What will be done at assessment?
Xray- to ensure an avulsion fracture has not occurred (where part of the bone is pulled away)
Stability testing to determine the grade of sprain and whether it is torn or not- If the ligament is torn there will be excessive movement (10-20 degrees more movement) at the joint compared to the other side
Treatment
-Partial tear- immobilization for at least 4 weeks, taping and other protective splints may also have to be used when returning to sport
- Full tear- surgery
- You may need to see a physiotherapist after a prolonged immobilization period to help you regain the full range of movement and strength in your wrist/hand after the immobilization period to help
Rehabilitation after immobilization period
Range of movement (ROM) exercises for thumb- bending and straightening your thumb, moving your thumb to away from your fingers, getting your thumb to touch each finger
ROM exercises for wrist which may also have become stiff- bending and straightening and moving it side to side
(When you do ROM exercises try to move to the end range to gain further movement rather than just practicing the movement in the range you already have)
Strengthening exercises
To improve grip strength- squeeze a tennis ball for 5 seconds and repeating
To improve thumb strength- squeeze a small soft ball between your thumb and each finger, also try placing a rubber band around your thumb and each finger and pulling away
Prevention
Wear your ski poles correctly (or don’t put your hands through the loops at all)- your hands should go up through the loop and then hold the pole and strap together so that when you fall the pole will hang down
2) Wrist fractures
The natural protective response when falling is to outstretch your hand to protect yourself. Snowboarders are more vulnerable to falling as unlike skiers when they loose their balance they are unable to step out with the other leg to regain balance- which is why wrist fractures are much more common in snowboarders.
Radial fracture
The most common bone to break is the radius (which is the bone on the thumb side of your forearm)- this is known as a Colles fracture
Symptoms
Pain, swelling
Inability to move the wrist/hand
Numbness of fingers
Deformity
Scaphoid fracture
The scaphoid bone (located in the first row of carpal (hand) bones) just above the radius is also another common fracture following a fall onto an out stretched hand
A scaphoid fracture does not always show up immediately so it is important that if the pain persists a follow up x-ray is re done 2 weeks later
It is important not to ignore continuous pain as left un treated it can lead to complications such as osteoarthritis
Symptoms
Pain and swelling in the anatomical snuff box (when you bend your thumb backwards you will see an indentation between two ligaments)
Pain
Bruising, swelling
Pushing up from a chair test- if you push up from a chair with your hands you will feel the pain
Management of fractures
If the bone is displaced too much surgery will be required
Surgery and non surgical options will then require a cast for around 6 weeks
You will then see a physiotherapist to help you regain your strength and movement
Exercises
Whilst in cast:
It is important to keep your fingers, elbow and shoulder moving to prevent these joints becoming stiff
After cast is removed:
Bending and straightening the wrist
Moving your wrist side to side
Turning your hand over each way
Add some over pressure (until you feel a stretch) to these exercises and hold for 30 seconds
Strengthening
Grip strengthening with tennis ball- squeeze for 5 seconds and repeat
With your hand facing upwards and a weight in your hand, bend your hand upwards
With your hand facing down and a weight in your hand, lift your hand upwards
Prevention of wrist fractures
Consider wearing wrist supports/guards
Learn to fall correctly
Consider getting professional lessons when starting snowboarding to ensure you have the right technique
