Dr Stuart Myers

13. Case Study Ski Instructor

Rene C, a 24 year old right hand dominant ski instructor at Thredbo.


  
     

 He fell down some icy stairs at work in Thredbo ski resort and injured his right thumb.(Not even skiing!)   He sustained a right Skier’s thumb.  



 
Examination revealed a grossly unstable thumb opening > 60* compared with 30* in the opposite thumb.
X-rays revealed that the ligament hand pulled off several small fragments of bone but they were not markedly displaced.

    
His appointment was arranged for surgery 4 days later and he was seen by me between operations to confirm his need for surgery. He was advised to arrive at the hospital fasted for 6 hours and he had his operation 2 hours later.

  

   

At operation the bone fragments were in 3 pieces and were not repairable so the fragments were removed and a bone anchor was used to re-attach the ligament to the bone, 

Full operation


Post surgery he returned to Thredbo the next day in a half cast,

 

This was converted to a full waterproof cast 8 days later and he returned to ski instructing after 10 days. The cast was modified so that he could hold a ski stock.

After 6 weeks the cast was removed and he skied with a removable splint. This was larger than I usually use but it was available in Thredbo. It could still easily fit under ski gloves.

   


He then started scar massage to reduce any scar irritability. At the time of surgery the small branches of the radial nerve are retracted in the wound to gain access to the joint. This can result in some altered sensation beyond the scar which improves over a few weeks to months.

The scar massage is also important to free up adhesions or scarring between the skin and the tendons and also between the tendons and the underlying bone. Tendon adhesions can result in stiffness at the end joint in the thumb.

The hand can be placed in warm water and stretching exercises commenced as shown. By holding the thumb as shown during stretching exercises little force is applied to the ligament repair.


Clearly the injury has not slowed him down greatly! 



This is the range of movement after 7 weeks. It is common to lose a few degrees of movement at both the operated joint and end joint of the thumb after Skier’s thumb surgery. The removable splint should be warn for 6 weeks when doing any activities with the hand but can be removed t night and when showering.


Appointments:
The winter time is a busy time for hand surgeons with ski  and football injuries. The doctors at Thredbo & Perisher Medical Centre’s are highly experienced and skilled at picking those patients who require surgery. If you have been told that you may require surgery ring my secretary to make a tentative booking for your operation while you are still at the ski fields. This surgery is best performed within 10 days, It is not so urgent that it needs to be performed immediately so you can finish you holiday.