Although a fall during skiing is one cause for this injury, it is most often associated with any injury that forces your thumb away from the palm of your hand. 

A ligament is a tough, fibrous band of connective tissue that connects two bones across a joint. Ligaments stabilise joints, including during joint movement.

The severity of any ligament injury can be graded as mild (grade 1), moderate (grade 2) or severe (grade 3). 

• Grade 1 ligament injuries represent a sprain, meaning that joint stability is maintained despite pain and inflammation at the site of injury (there may be microscopic tears of some of the ligament fibres). 

• Grade 2 ligament injuries are partial tears of the ligament, whereby pain is associated with some laxity but the overall stabilising effect of the ligament is maintained. 

• Grade 3 ligament injuries represent complete tears of the ligament with no (or very little) joint stability being maintained.

Untreated grade 3 UC ligament tears (and some grade 2 tears) can lead to long-term pain and thumb instability.

Some of the potential symptoms of a thumb UC ligament injury are listed below. Symptoms can vary depending on the grade or severity of the injury.

Typically present:

• Pain at the site of the UC ligament and middle joint of your thumb (MCPJ). This pain is usually made worse when gripping objects (e.g. pinch grip or holding a pen).

Sometimes present:

• Swelling and inflammation at the site of the UC ligament and middle joint of your thumb (MCPJ). 

• Bruising (when first injured).

• Unreliable, unstable or weakness of grip.

Some of the potential symptoms of a thumb UC ligament injury are listed below. Symptoms can vary depending on the grade or severity of the injury.

Typically present:

• Pain at the site of the UC ligament and middle joint of your thumb (MCPJ). This pain is usually made worse when gripping objects (e.g. pinch grip or holding a pen).

Sometimes present:

• Swelling and inflammation at the site of the UC ligament and middle joint of your thumb (MCPJ). 

• Bruising (when first injured).

• Instability or weakness of grip.

It is important to correctly diagnose a UC ligament injury and exclude other causes of thumb pain, such as trigger finger/thumb or arthritis.

The diagnosis is usually made on the history (your symptoms) and clinical examination. Plain radiographs (X-rays) are useful to help to exclude a fracture (break). An ultrasound or MRI scan can help when the diagnosis or injury severity is unclear.

Treatment depends on the severity of the ligament injury. 

• Non-surgical treatment is used for sprains (grade 1) and partial stable tears (grade 2) with immobilisation and rest in a cast or splint.

• Surgical treatment is usually reserved for complete and unstable tears of the UC ligament (grade 3). Surgery aims to repair the ligament. Sometimes ligament reconstruction with a tendon graft is required (especially if more than a few months have passed since the original injury). The option to operate or not will require a thorough assessment, which often includes thumb X-rays (to exclude a fracture) and sometimes a scan like an ultrasound or MRI. Some complete tears can be considered for non-surgical treatment (e.g. a cast for several weeks) but if the torn ligament is displaced into a position where healing may not be possible (termed a Stener lesion) then surgery will usually be recommended.

Matthew offers all the above treatments. He can refer you for casts, splints and hand therapy if required.

Surgery for skier’s thumb (UC ligament injury) is often performed under general or regional anaesthesia. Click here for an overview of the different types of anaesthesia and the general risks of hand surgery.

The specific risks associated with thumb UCL surgery will be discussed if surgery is an option, but includes stiffness and failure of the repair (recurrent instability).

You can read more detailed information about thumb UC ligament injuries on the Lothian Hand Unit website.

The British Society for Surgery of the Hand (BSSH) has an informative webpage on thumb UC ligament injuries which can be downloaded as a patient information leaflet PDF.