Skier’s Thumb

A thumb sprain is an injury of the main thumb ligament at the base of the thumb, the ulnar collateral ligament. Skier’s thumb is another term for a thumb sprain. Ligaments are the soft tissue components that hold two bones together to stabilize a joint. You weaken your pinching and grasping abilities if you tear the ulnar collateral ligament. Because of the popularity of recreational skiing in the United States, skier’s thumb is a common orthopedic injury. When the ulnar collateral ligament is completely torn, the injury must be surgically repaired.

What is the cause of skier’s thumb?

It is normal to extend your arms in front of you when you fall. People do this to reduce the impact from hitting the ground. With skiers and other who pitch forward, falling on the hand can stretch or tear the ulnar collateral ligament. Another cause of this injury is an automobile accident, with the driver’s thumb being impacted over the steering wheel. Basically skier’s thumb can result from any injury where the thumb is abnormally bent backward or to the side.

What are the symptoms of skier’s thumb?

The signs and symptoms of skier’s thumb can occur minutes to hours after the initial injury:

Swelling of the thumb
Pain at the base of the thumb and in the space between the thumb and index finger
Bruising of the skin over the thumb
Inability to grasp or weak grasp
Tenderness along the index finger side of the thumb
Thumb pain that is worse with movement
Pain in the wrist

How is skier’s thumb diagnosed?

To determine if you have a sprained thumb, I will examine your thumb in different positions to determine if your joint is stable. Also, diagnosis depends on your signs and symptoms as well as the history of your injury. I may perform X-rays to evaluate the joint with tension applied to the injured ligament. In addition, I check for normal functioning of the three major nerves of your hand.

What is the treatment for skier’s thumb?

Nonsurgical Treatment

Treatment depends on whether the ligament is stretched, partially torn, or completely torn. If only stretched or partially torn, I immobilize your thumb joint with a splint or bandage until it heals. For relief of pain and swelling, I recommend ice application 3 or 4 times each day. You will wear the splint or bandage for at least three weeks. After a specified amount of time, I encourage you to do strengthening exercises for your thumb. Physical therapy helps with this. This will continue for another 2 or 3 weeks. Most stretching and partial tearing injuries of this ligament heal after 4 to 6 weeks.

Surgical Treatment

When the ulnar collateral ligament is completely torn, surgery is often necessary. This procedure involves reconnecting the ligament to the bone to regain normal movement. With a skier’s thumb injury, the fragments of the bone may be pulled away with the torn ligament. These types of injuries require fixation with a pin or screw. After your surgical procedure, you will wear a short arm cast or splint for 6 to 8 weeks while the ligament heals.

What is my prognosis like with skier’s thumb?

The prognosis of this type of injury depends on the severity of the tear, how soon you get treatment, and your current bone and joint health. If a sprained thumb is treated promptly and properly, full normal function will be preserved and restored. If you delay treatment of skier’s thumb, however, chronic weakness, instability, and/or arthritis could develop. These late complications can be repaired with a joint fusion procedure or ligament rebuilding procedure.

Can I prevent skier’s thumb?

If you ski, you should discard the ski pole when you fall. Falling onto an outstretched hand without the pole will lessen your chance of a sprained thumb. Also, you should use a ski pole with finger-groove grips without restraining devices such as a closed grip or a wrist strap.

What should I do if I suspect I have skier’s thumb?

If you think you have sprained your thumb, I recommend you be evaluated as soon as possible in our office. While you are making your appointment, apply ice to the injury for around 30 minutes at a time. Avoid moving the thumb, and immobilize it with an ACE wrap. Take some ibuprofen for pain relief and anti-inflammation action.

Wrist and Elbow Fractures

Distal Radius Fracture

The radius is the larger of the two forearm bones. The end near the wrist is referred to the distal end, and the end close to the elbow is called the proximal end. Distal radius fractures are breaks in the radius bone close to the wrist. Most distal radius fractures occur when you fall onto an outstretched hand or from a car accident or other trauma. When the distal radius fractures, there will be instant pain, bruising, swelling, and limited range of wrist motion. Sometimes, the wrist will appear deformed or out of alignment.

To diagnose a distal radius fracture, I will need to take an X-ray of the wrist. An open fracture is where the bone breaks through the skin. If the fracture extends into the joint, it is called an intra-articular fracture. Fractures that do not go into the joint are extra-articular fractures.

Treatment of a distal radius fracture involves the immediate measure of stabilizing the arm and applying an ice pack. You do this to protect the injury from further insult and to decrease swelling and control pain. One nonsurgical option is casting done if the bone is in good position. I may find it necessary to straighten (or reduce) the bone to align it correctly. Surgery is necessary when the bone must be reduced through an incision. This is called an open reduction, and these procedures often require pins, plates, and/or screws to hold the bone pieces in place.

Scaphoid Fracture of the Wrist

The scaphoid bone is one of the many small bones of the wrist. It is located on the thumb side of the wrist where the bending occurs, just above the radius bone. When the scaphoid bone fractures, you will have pain, decreased wrist movement, bruising, swelling, and tenderness.

Most scaphoid fractures occur when you fall onto an outstretched hand. To diagnose a scaphoid fracture of the wrist, I will need to do X-rays to evaluate for displacement. Many times, however, a break in this area does not show up right away. If I suspect the scaphoid is fractured, I usually apply a wrist splint for a couple of weeks and have you come back for a repeat evaluation and possibly an MRI.

Treatment of a scaphoid fracture depends on the exact location of the break. Those that are near the thumb typically heal in a few weeks with protection. If the fracture is more complicated, I may apply a cast to the wrist and monitor the healing. Breaks of the middle area of the scaphoid are more difficult to heal due to limited blood supply.

I often recommend surgery for these types of scaphoid fractures. I make a small incision and insert metal implants to hold the bone in place while it heals. In rare incidences, a bone graft is necessary. Whether or not surgery is necessary, you may need to wear the cast or splint for as long as six months.

Elbow Fractures

The bony aspect of the elbow that extends from the ulna arm bone is called the olecranon. This prominence is located under the skin with little protection from the soft tissues or muscles. The elbow joint consists of three bones, and these allow it to bend and straighten like a hinge. The humerus is the upper arm bone, the radius is the thumb side lower arm bone, and the ulna is the pinky side lower arm bone. When the elbow is injured, either by breaking one of these bones or by tearing a ligament that connects one bone to another, it can be stiff, painful, and unstable.

Elbow fractures occur from a direct blow, such as being hit with a baseball bat, or indirectly from landing on an outstretched arm with the elbow locked out straight. Symptoms of a fracture of the elbow include sudden intense pain, swelling, bruising, inability to straighten the elbow, numbness in one or more fingers, pain with joint movement, and tenderness. In order to diagnose an elbow fracture, I must examine the injury and take an X-ray of the joint.

Treatment depends on the extent of the injury. Some fractures of the elbow only require a splint, sling, or cast and conservative measures, while others require surgical intervention. If the bones are out of place, or if there are pieces of bone cutting through the skin, surgery will be needed.

Generally, I make an incision over the back of the elbow and hold the bone pieces and other structures together with pins, wires, plates, screws, and/or sutures. Once the surgery is over, I apply a cast for a short period of time and restrict activity to allow for healing.

Shoulder Injury and Shoulder Stiffness

Shoulder injuries occur from athletic activities that involve repetitive, excessive, overhead motion, such as pitching baseball, tennis, swimming, and weightlifting. Injuries to the shoulder also happen from doing everyday activities, such as hanging curtains, washing walls, or lifting the laundry basket. The shoulder is a complex joint that connects with muscles and tendons to allow full range of motion of the arm.

The shoulder consists of the head of your upper arm bone (the humerus), your shoulder blade (the scapula), and your collarbone (the clavicle). The humerus fits into a round socket called the glenoid. The rotator cuff is a combination of tendons and muscles that keep your humerus in alignment.

The shoulder’s unique mobility leads to problems of impingement of the bony structures or the soft tissues as well as instability. With some shoulder injuries, you may only feel pain with movement of the joint. Others, however, result in pain at rest.

What are the types of shoulder injuries?

Most shoulder injuries fall into one of the four major categories: (1) tendon inflammation or tear; (2) instability; (3) arthritis; and (4) fracture.

Rotator Cuff Tears – The rotator cuff is one of the most significant structures of the shoulder. This component allows you to lift your arm and reach overhead. When your rotator cuff is injured, you will have loss of function of the shoulder.

Bursitis – A bursae is a small, fluid-filled sac that is located in the shoulder joint and other joints of the body. When the bursae is inflamed and swollen, there is loss of cushion between the bones and the overlying soft tissues that reduce the friction of the gliding motion. This condition is called bursitis, and it can cause the shoulder to have pain and loss of function.

Tendinitis – A tendon is a cordlike structure that connects muscle to bone. Tendinitis of the shoulder is the result of wearing down of the tendon from overuse. The acute form of tendinitis results from excessive throwing or other overhead activities during sporting activities or work. Chronic tendinitis is due to age, and there is degeneration of the tendon with this condition.

Tendon Tears – The tendon can split and tear from an acute injury or degenerative changes related to the aging process, long-term overuse and wear and tear, or from sudden trauma. Tendon tears can be partial or complete.

Impingement – Shoulder impingement is the result of the top of the shoulder blade putting pressure on the underlying soft tissues during arm lifting. The blade rubs on the bursa and rotator cuff causing limited movement and pain. If left untreated, severe impingement can result in rotator cuff tearing.

Instability – The shoulder is considered unstable when the head of the humerus is forced out of the socket. Instability occurs from sudden trauma or due to overuse of the joint. Dislocations can be partial (called subluxation), where the ball of the upper arm just partially comes out of socket. A complete dislocation is where the ball comes all of the way out of position. If the surrounding support structures are torn or loose, dislocations can occur repeatedly. Shoulder instability leads to increased risk of arthritis.

Arthritis – When there is wear and tear on a joint with inflammation, the joint is considered to have arthritis. Shoulder joint arthritis causes stiffness, decreased range of motion, crepitus, and pain. This type of injury is more common among older people.

Fracture – A fracture is a broken bone. Shoulder trauma can result in a fracture of the humerus, the clavicle, or the scapula, and this causes severe pain, bruising, and swelling of the shoulder.

What can I expect at the doctor’s examination?

If you have a shoulder injury, you should seek medical attention immediately. I will conduct a thorough evaluation in order to determine the cause of your shoulder pain and offer prompt treatment. During the physical examination, I inspect your shoulder for physical abnormalities, deformity, muscle weakness, tender areas, and swelling.

It is also necessary for me to assess your joint range of motion and strength. To properly evaluate your injury, I will take X-rays and possibly order a MRI, CT scan, and/or ultrasound. An arthroscopy is a surgical procedure where I look inside the joint with a tiny camera to evaluate the extent of the injury. This may be necessary for repair and diagnosis of certain shoulder injuries that are complex.

What is the treatment for shoulder injury?

The treatment of your shoulder injury depends on the type of injury. Some of the various options that I utilize include:

Activity Changes – Treatment typically involves alteration of your activities and rest so your shoulder can regain strength and flexibility.

Physical Therapy – Certain types of shoulder injuries require physical therapy. This treatment involves exercises and range of motion techniques that help you regain strength and motion of the shoulder joint.

Medications – I often prescribe certain medications to reduce inflammation and pain. Also, specific shoulder injuries require injections of anesthetics or steroids.

Surgery – While some shoulder injuries respond to conventional treatment modalities, others require surgical correction and intervention. Rotator cuff tears and recurring dislocations often require surgery. I also perform arthroscopic procedures to remove scar tissue and repair torn tissues for some shoulder injuries.

An Overview of Congenital Hand Deformities

Congenital anomalies are deformities that your child has at birth. Congenital hand deformities are particularly disabling for children and present a challenge to the orthopedic specialist. These deformities vary from minor types, such as a digital disproportion, to severe forms, such as the total absence of a bone.

If your child has a congenital hand deformity, I recommend early consultation with an orthopedic specialist who specializes in hand surgery. Reconstructive surgery may not be an option for your child, but I have many different prosthetic devices that can increase hand function for your child.

What are the different classifications of congenital hand deformities?

I use the classification for hand deformities accepted by the American Society for Surgery of the Hand (ASSH). This classification system recognizes six groups of deformities.

Problems in Development of the Parts – This occurs when a specific part or parts of the body stop developing when the baby is in the womb. This results in either complete absences of the hand or a missing structure, such as the thumb. Two kinds of problems in development are radial clubhand and ulnar clubhand. Radial clubhand is a type of deformity involving the tissue on the thumb side of the forearm and hand. This condition could lead to shortening o the bone, absence of the thumb, or a small thumb.

I typically operate on radial clubhand at age 6 months. Ulnar clubhand is a deformity where there is underdevelopment of the bone on the side of the little finger (the ulna). This could result in absence of the little finger or a short fifth digit.

Failure of Parts of the Hand to Separate – This occurs when either the bones or the tissues fail to separate in the womb. The most common form of this congenital anomaly is syndactyly, the condition where two or more fingers fuse together. This condition typically involves both hands. Simple syndactyly involves the fusion between the tissues only, whereas complex syndactly involves the fusion between the bones.

Contractures of the hand develop when there is failure of the cells to differentiate during formation in utero. With a contracture, there is abnormal pulling forward of the digits of the hand, and the digits are unable to extend. Surgery is necessary for children with this condition and is recommended around the age of 3.

Duplication of Digits – This is also called polydactyly, and the little finger is most commonly affected. There are three types of polydactyly: 1, 2, and 3. With type 1, there is an extra digit attached by nerves and skin only. Type 2 involves an extra digit attached to the bone or joint. Type 3 is more complex, with an extra digit connected to extra normal metacarpal bone of the hand. Surgery can easily correct these types of deformities.

Undergrowth of Digits – When fingers or thumbs are underdeveloped, there could be a digit that is small, missing muscles or bones, or the complete absence of a digit. Surgery is not always necessary for the correction of these types of deformities.

Overgrowth of Digits – When there is an abnormally large digit, the medical term used is macrodactyly. Some conditions also involve the forearm. The most common digit that overgrows is the index finger. Surgical treatment is complex and I often recommend complete amputation of the large digit.

Congenital Constriction Band Syndrome – This condition is the result of the formation of a tissue band around a finger or limb. This causes problems of blood flow and normal growth. The cause of this syndrome is unknown, but some experts believe that amniotic banding leads to constrictions around a finger or limb. There are four degrees of severity, ranging from simple constrictions to serious constrictions where amputation is necessary.

What is the treatment for congenital hand deformities?

I base treatment of congenital hand deformities on several factors. These include:

The extent of the condition
The cause of the condition
The child’s age, medical history, and overall health status
The child’s tolerance to procedures, medications, and therapies
The parents’ opinion and preference

Treatment measures include:

Splinting the affected limb
Correction of contractures
Limb manipulation and stretching
Tendon transfer
Skin grafting to replace or attach skin that is missing or removed during the procedure
Physical therapy to increase function and strength
External appliances to realign misshapen hands or digits
Prosthetics used when surgery is not an option or in conjunction to surgery

Surgical Correction

When is surgical correction performed?

Surgery that is performed within the first 2 years of life is considered early surgery. There are several advantages to early surgery including potential for growth and development, improved scarring, early use of the reconstructed portion, and reduce psychological impact. The disadvantages to early surgery are possible increased anesthetic risk and technical difficulties. Most surgical correction is done after the age of 2 or 3.

What are the different types of surgeries to treat congenital hand deformities?

There are several methods of surgery I perform to treat congenital hand deformities. These include:

Reduction and Fixation of a Broken Bone – This procedure can be open or closed depending on the type of deformity or injury. Many times, I employ a combination of the open and closed approaches using internal fixtures to realign broken or misshapen bones. Immobilization of the hand with a splint follows to assure that the fracture heals properly.

Drainage and Debridement – This technique is done when there is formation of an abscess from infection. This promotes faster healing of the affected region.

Micro-Surgical Replantation – This procedure involves the reattachment of the finger, part of the finger, or hand by way of precise micro-surgical methods.

Skin Grafting – During this method, skin is taken from a healthy body area and used to replace the skin missing on the hand. This is done when there is an amputation of a finger or portion of a finger and in burn deformities.

Skin Flap – This procedure is used when there is damage to the deep tissues of the hand. The tissue take from an area of the body has fat, muscles, and blood vessels that must be attached during the operation.

Tendon and Nerve Repairs – Some hand deformities require repair of a tendon and/or nerve component. These deformities cause decreased movement of the hand, numbness, and weakness.

Dr. Peterson to Host Joint Seminar – Wednesday February 13th

Our own Dr. Peterson will be hosting a seminar this Wednesday, February 13, 2013 at the Swedish Hospital Campus in Ballard.

See below for registration information and event times.

Joint Replacement: The Right Choice for You? – Ballard

Campus: Swedish/Ballard
Wednesday, February 13, 2013
6:00 PM (Americas) Pacific Time (US & Canada)
6-8 p.m.

If you have arthritic joint pain and are considering joint replacement, you’ll want to attend this important class. An orthopedic surgeon will discuss hip- and knee-replacement surgery, as well as the latest in robotic-assisted surgery for those who have advanced arthritis in part of their knee. There will also be a question and answer session with the surgeon.

Click Here to Register Now!

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