Pain guide · Wrist and hand pain

Skier's thumb: a torn ligament at the base of the thumb, splint or surgery, and the exercises

Skier's thumb is a sprain or tear of the ligament on the index-finger side of the thumb's knuckle, when a fall or a ball forces the thumb away from the hand. It is also called gamekeeper's thumb. Most sprains and partial tears heal in a splint, but a complete tear can leave the thumb weak and loose, so it needs a hand specialist's assessment within days.

UK guidance asks for a shared decision on treatment within 2 weeks of referral to a specialist. For a complete tear, early surgery and a cast or rigid splint are both reasonable, and the evidence for either is very limited. This guide explains the signs, what X-rays and scans can and can't show, the evidence for each route, and a staged plan with 3D demos and written thumb exercises.

3-stage exercise plan When to get help 27 sourcesUpdated 21 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E after an injury (don't drive yourself) if the arm, wrist or hand is numb, tingling or has pins and needles; a bone is sticking out or a bad cut is bleeding heavily; or the wrist, thumb or a finger has changed shape, is at an odd angle, or has turned blue, grey, white or cold.
Call 999 or go to A&E: you heard a crack or snap when you hurt it, or the pain is severe and you can't move the thumb or hold things.
Same day (NHS 111, an urgent treatment centre or an urgent GP appointment): a thumb injury that is very painful, swollen and bruised, stiff or difficult to move. It may be broken, dislocated or a torn ligament, and you'll probably need an X-ray.
Within days: after the thumb was bent back or away from the hand, pain and swelling at the base of the thumb on the index-finger side, especially with a weak or painful pinch, a loose or wobbly feeling, or a lump there. Ask to be seen in a hand clinic: a complete tear needs a decision on treatment within 2 weeks of referral, and it is easily missed in A&E.
Same day, in a cast or splint: it feels too tight, or the fingers are numb, swollen, blue or white.
After an operation, oozing or pus from the wound: ask for an urgent GP appointment or get help from NHS 111. If you feel unwell or feverish and the wound looks infected, go to A&E.
Throbbing pain and swelling in the arm, with red, blue or darker skin and swollen veins: ask for an urgent GP appointment or get help from NHS 111. It could be a blood clot.

See a doctor or physiotherapist if

Still painful, weak or loose when pinching after the splint or cast comes off: go back to your hand clinic. The ligament occasionally doesn't heal, and further surgery can help.
A child or teenager with a thumb injury: proper thumb X-rays are needed, not just hand X-rays. A piece of bone pulled off where the ligament attaches may need a hand surgeon.
You have diabetes and a hand problem: the NHS says hand problems can be more serious if you have diabetes.

Understand it

What it is

The thumb's knuckle (the metacarpophalangeal joint) is steadied on the index-finger side by the ulnar collateral ligament (UCL), which takes the load when you pinch or grip. A force that bends the thumb away from the hand sprains or tears it. Clinicians grade it: grade 1 is a sprain with no extra looseness, grade 2 a partial tear that is looser but still stops firmly when tested, and grade 3 a complete tear with no firm stop. Sometimes a small piece of bone comes away with the ligament (an avulsion fracture).

Gamekeeper's thumb first described the same ligament stretching slowly over years; skier's thumb is the sudden injury. The ligament on the other side of the knuckle, the radial collateral ligament, is injured about 10 times less often.

Sources 1, 2, 3, 4, 5

The Stener lesionMixed evidence

In a Stener lesion, the torn end of the ligament flips over a sheet of thumb muscle (the adductor aponeurosis), which then lies between the ligament and the bone, so the ligament can't heal back by itself. How often this happens in complete tears varies hugely between studies, from 11% to 87%. The UK guideline found no study showing that a Stener lesion can be reliably diagnosed by examination or by a scan.

Sources 1, 5, 3, 6

Who gets it

About 50 in every 100,000 emergency department visits are for this injury. In skiing it is by far the commonest hand injury and may be the commonest ski injury of all, though it often goes unreported; the pole is the probable cause, since snowboarders rarely get it. At one Vermont resort it became less common in skiers over 18 seasons. In an Italian ski hospital, 33 of 195 people with forearm, wrist or hand injuries (17%) had a torn thumb UCL alone, often after the pole caught.

It also happens in ball sports, hockey, falls and tackles: anything that forces the thumb away from the hand.

Sources 7, 3, 8, 9, 10, 5, 11

How it's recognised

Pain, swelling and bruising at the base of the thumb on the index-finger side, pain and weakness when pinching, and sometimes a loose feeling or a firm lump, which can be a Stener lesion. The key test is a specialist's stress test: gently pushing the thumb sideways with the knuckle straight and then bent, and comparing it with the other thumb. A local anaesthetic injection sometimes helps, though most UK clinicians rarely or never use one.

The UK guideline counts the thumb as significantly loose if there is no firm stop, it opens more than 30°, or it opens more than 20° further than the other thumb. The injury is easily missed: junior A&E doctors correctly diagnosed only 45% of complete tears in one UK study.

Sources 1, 5, 6, 7, 3, 12

What X-rays and scans do and don't showMixed evidence

X-rays in two directions are part of the first assessment, mainly to look for a piece of bone, and children need proper thumb views. A fragment that has moved back past the joint (the displaced fleck sign, seen in 7.5% of 228 people) meant a complete tear in all of them and a Stener lesion in 94%.

Ultrasound and magnetic resonance imaging (MRI) are used routinely in some centres (46% of 37 UK centres). Pooled studies suggest ultrasound is accurate for Stener lesions, but every study had a high risk of bias, and across 12 studies in the UK guideline its sensitivity ranged from 40% to 100%. In one recent UK series, 37% of the tears that ultrasound called complete, and that went to surgery, had an intact ligament, though an older UK series found ultrasound right 94% of the times it showed a tear. MRI picked up damage to the ligament well (97%) but was less accurate about the type of tear, and it didn't change who needed surgery beyond a careful examination.

The UK guideline found too little evidence to recommend routine ultrasound or MRI.

Sources 6, 13, 14, 7, 15, 16, 12, 17

How it usually goes

Sprains and partial tears usually heal well in a splint or cast. For complete tears the outlook is less certain: in groups treated in splints and reported in 1989 and 1995, 7% to 15% didn't settle and needed surgery. A complete tear that stays loose can cause long-term pain, a weak pinch and arthritis, and old injuries may need a tendon graft or a fusion of the joint.

Recovery takes time: one NHS trust says full recovery after a collateral ligament injury can take 3 to 6 months.

Sources 1, 6, 18, 19, 20, 5, 21

What helps, and how strong the evidence is

Get it assessed within days: the 2-week decisionEmerging evidence

The British Society for Surgery of the Hand's 2023 guideline asks for assessment with the history, an examination and X-rays, then a shared decision on treatment within 2 weeks of referral to a specialist service that can operate. Its evidence covers injuries up to 3 weeks old, and the recommendation rests on expert agreement and low-quality evidence.

Repairs done late can need a tendon graft instead, which left fewer thumbs stable (81% against 95% after earlier repairs) in a review of 616 thumbs.

Sources 6, 22

Splint or surgery for a complete tear: both reasonable, on thin evidenceMixed evidence

The UK guideline (British Society for Surgery of the Hand, 2023) says it is reasonable to offer either early surgery or treatment in a cast or rigid splint for a thumb that is significantly loose, and rates the evidence as very low quality. No study has compared the two directly. The society's own patient page says a complete tear is repaired, which differs from its guideline, so you may come across both views.

For surgery: in reviews of case series, 95% of thumbs were stable after a repair and 93% to 96% of people got back to unrestricted activity, with no technique better than another. For a splint: in a 1995 study, 34 of 40 complete tears (85%) healed in a splint worn for 8 to 12 weeks, and the 6 that stayed loose did well after later surgery; in a 1989 study of 32 people with a custom splint, more than 90% had good or satisfactory results. These are small studies without comparison groups. In a survey of 37 UK centres, a cast or splint for a complete tear treated without surgery was most often worn for 6 weeks (58%) or 4 weeks (30%).

A Dutch trial, MUSCAT, is comparing a cast with immediate surgery for complete tears, including Stener lesions. It is still to report.

Sources 6, 23, 1, 22, 24, 19, 18, 7, 3

Stener lesions: most surgeons operate, but no test reliably shows oneMixed evidence

In an international survey of 262 hand surgeons, 95% would operate on a Stener lesion and 79% on a displaced bone fragment. They split on complete tears without a Stener lesion: 59% preferred surgery, and a quarter would never treat a complete tear without it.

Yet the UK guideline found no study showing that a Stener lesion can be reliably diagnosed by examination or a scan, and in the 1989 splint study, the thumbs thought to have one also did well, though they ended up less stable.

Sources 25, 6, 18

Sprains and partial tears: a splint, then exercisesStrong evidence

Without significant looseness, the UK guideline advises treatment without surgery. A splint or cast for about 4 to 6 weeks is usual, then exercises to bring back movement and strength. People with pain but good function, no significant looseness and normal X-rays may be discharged with advice on what to watch for.

Sources 6, 1, 2, 5

After a repair, moving earlyEmerging evidence

Starting movement early after a repair gave some early benefits in low-quality studies, and the UK guideline supports it when it is safe. Holding the joint still with a wire across it caused more pain without making the thumb more stable.

Sources 6, 23, 24

Getting back to sportEmerging evidence

After surgery, 98% of 311 athletes returned to their sport, and every expert in the review advised protecting the thumb with a splint or tape at first. Timing varied by sport, from protected play at 2 weeks in some American football players to 6 to 8 weeks in basketball. NHS hand therapy protocols expect full grip, pinch and sport from about 9 to 12 weeks. These figures come from low-quality studies and hospital protocols, which differ.

Sources 4, 2, 26

How much pain is OK while you exercise?

No sideways stress while it heals, then the hand ruleEmerging evidence

While the ligament is protected, in or just out of the splint, do only the movements your therapist has given you. NHS hand therapy leaflets say no outward stress on the thumb when it is straight or spread, no heavy gripping or pinching, and no spanning the hand wide to open or grasp things. Keep any discomfort mild, about 0 to 3 out of 10, and settled within the hour (our numbers).

Once your team says the thumb is stable, often from about 6 to 8 weeks, our wrist and hand rule applies: discomfort up to about 5 out of 10 that settles within half an hour and is no worse the next morning. Forceful pinching comes back last. A feeling of the thumb giving way, a new lump or a sudden loss of pinch isn't part of the rule: see your hand clinic.

Sources 11, 2, 21, 1

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Protect the ligament; keep everything else moving (often weeks 0 to 4 or 6, as your team allows)

As your team allows. Wear the splint or cast as instructed, all the time if you are told to, including in bed. Keep the hand raised early on, and use ice for 10 minutes at a time for the first 3 days. Bend and straighten the tip of the thumb inside the splint if your therapist allows (written steps in the notes below). Avoid using the thumb for tasks, especially spanning the hand to open or grasp things, and keep the fingers, wrist (if the splint leaves it free), elbow and shoulder moving.

Tendon glides (hand tendon gliding exercises) demonstrated on the 3D figure

3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment

4 to 6 of each position, holding each 5 s, up to 4 times a day · Bend and straighten the fingers over the splint. An NHS hand-therapy leaflet's dose

Harder: Ball squeeze

Wrist & forearm flow demonstrated on the 3D figure

3D demoWrist & forearm flowBeginner · No equipment

10 slow repetitions, 3 to 4 times a day · Only if your splint or cast leaves the wrist free. Editorial dose

Harder: Wrist flexor stretch

Elbow bend and straighten (elbow range of motion) demonstrated on the 3D figure

3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment

10 slow repetitions, 2 to 3 times a day · Editorial dose

Harder: Dumbbell biceps curl

Shoulder CARs (controlled articular rotations) demonstrated on the 3D figure

3D demoShoulder CARs (controlled articular rotations)Beginner · No equipment

3 slow circles each way, once or twice a day · The move page's dose

Easier: Arm circles · Harder: Sleeper stretch

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

20 to 30 minutes · Without holding the rails with the injured hand. Editorial dose

Harder: Treadmill jogging

Move on when: Your team checks the thumb and says it is stable enough to come out of the splint for exercises, often at 4 to 6 weeks.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Get the thumb moving (often weeks 4 or 6 to 8, as your team allows)

As your team allows. Gentle thumb movement in every direction (written steps in the notes below), several times a day, with the splint on between sessions and for risky activities. No outward stress on the thumb when it is straight or spread, and no heavy gripping or pinching. One NHS trust allows light use of the hand in the splint from about 4 to 6 weeks, then builds up use at 6 to 8 weeks with the splint kept for heavy tasks and sport.

3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment

4 to 6 of each position, holding each 5 s, up to 4 times a day · Now out of the splint

Harder: Ball squeeze

3D demoWrist & forearm flowBeginner · No equipment

10 slow repetitions, 3 times a day · Editorial dose

Harder: Wrist flexor stretch

Wrist circles demonstrated on the 3D figure

3D demoWrist circlesBeginner · No equipment

10 slow circles each way, 2 to 3 times a day · Editorial dose

Harder: Wrist flexor stretch

Wrist flexor stretch demonstrated on the 3D figure

3D demoWrist flexor stretchBeginner · A wall

2 to 3 gentle holds of 20 to 30 s · Keep the thumb tucked in, not pulled back. Editorial dose

Easier: Wrist circles · Harder: Quadruped wrist rocks

Move on when: The thumb moves comfortably, your team confirms it is stable, and a light pinch doesn't hurt.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Strength, pinch and back to sport (often weeks 8 to 12 and beyond, as your team allows)

As your team allows. Rebuild grip and pinch strength 2 to 3 times a week (the strengthening steps in the notes below), then return to full activity, including grip, pinch, weight through the hand and sport, from about weeks 9 to 12 in one NHS trust's protocol. Protect the thumb with a splint or tape when you first go back to sport. Skiers: practise letting go of the pole as you fall.

Ball squeeze demonstrated on the 3D figure

3D demoBall squeezeBeginner · Other / check instructions

Squeeze firmly, hold 3 to 5 s, 10 times, once or twice a day · A soft ball at first if the base of the thumb is sore. Editorial dose

Harder: Band finger extension

Band finger extension demonstrated on the 3D figure

3D demoBand finger extensionBeginner · A band

2 sets of 10 to 15 · Once spreading the thumb is comfortable. Editorial dose

Easier: Ball squeeze · Harder: Plate pinch

Wrist curls demonstrated on the 3D figure

3D demoWrist curlsBeginner · A dumbbell

2 sets of 12 to 15, light · Editorial dose

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Reverse wrist curl demonstrated on the 3D figure

3D demoReverse wrist curlBeginner · A dumbbell + A bench or box

2 sets of 12 to 15, light · Editorial dose

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Dumbbell forearm rotation demonstrated on the 3D figure

3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box

2 sets of 10 · Editorial dose

Easier: Wrist-extensor eccentrics · Harder: Plate pinch

Farmer's carry demonstrated on the 3D figure

3D demoFarmer's carryBeginner · A dumbbell + A kettlebell

Start light, 3 carries of 20 to 30 m · Editorial dose

Harder: Suitcase carry

Move on when: Full, pain-free movement, a pinch and grip close to the other hand, no loose feeling, and your team agrees.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Typical timings, which your team may change

These come from NHS hand therapy leaflets, and they differ. Your hand therapist's timings come first.

After a sprain or a tear treated without surgery: a splint or cast for about 4 to 6 weeks, worn all the time if you are told to, including in bed. Don't heat it, wet it or alter it.
After a repair: a cast for 2 to 4 weeks, then a removable splint and hand therapy.
Light use of the hand in the splint from about 4 to 6 weeks, and the splint only for heavy tasks and sport at 6 to 8 weeks, in one NHS trust's advice.
Full grip, pinch, weight through the hand and sport from about 9 to 12 weeks.
After a repair, one NHS trust suggests office work at 6 to 8 weeks, driving at about 8 weeks, and manual work and sport at 12 weeks.
Full recovery can take 3 to 6 months.

Sources 11, 21, 2, 26, 1

Thumb movement exercises (written steps)

These come from NHS hand therapy leaflets. The week numbers are from one hospital's protocol after a repair; after a sprain or a tear treated in a splint, other NHS leaflets give similar steps and timings, and your therapist adapts them. Do only what your therapist has cleared.

1. In the splint, if your therapist allows: bend and straighten the tip of the thumb.
2. Out of the splint (from about week 6 in one protocol): touch the thumb to the tip of each finger in turn, and at the little finger slide the thumb down towards the palm. Repeat 10 times.
3. Lay the hand flat on a table and lift the thumb up above the hand. Hold 5 s, then lower. Repeat 10 times.
4. Turn the palm to face the floor and lower the thumb to point at the floor, then bring it back. Repeat 10 times.
5. Don't push the thumb outwards when it is straight or spread, and don't pinch hard, until your therapist says so.

Sources 2, 11, 21

Thumb and pinch strengthening (written steps)

From about weeks 9 to 12 in one NHS trust's protocol, once your therapist agrees.

1. Wrap a rubber band around the fingers and thumb. Bring the thumb out in front of the palm, hold 3 s and return. Repeat 10 times.
2. Wrap a rubber band around the thumb. Keep the thumb touching the index finger while the other hand pulls on the band.
3. Wrap a rubber band around the thumb. Move the thumb away from the index finger, hold 3 s and return. Repeat 10 times.
4. Hold a pen across the palm. Squeeze it with the base of the thumb and the little finger, hold 3 s and relax. Repeat 10 times.

Source 2

Back on the slopes

Let go of the pole as you fall: it levers the thumb outwards as the hand hits the snow. Pole grips with a protective bow once helped but are no longer made, and quick-release straps and gloves with thumb supports haven't been tested. When you first go back to skiing or other sport, protect the thumb with a splint or tape.

Sources 8, 10, 4, 1

Positions to swap, and why

Habit or position	Why it matters	Instead
Strapping it and carrying on after a fall onto the thumb, without an assessment	Complete tears are easily missed (junior A&E doctors recognised 45% in one study), and the treatment decision should be made within 2 weeks of referral.	Ask for a hand clinic assessment within days.
Opening jars, wringing cloths or pinching hard while it heals	Heavy pinching and sideways stress load the healing ligament.	Use the other hand or a jar opener, and build up light pinching from stage 3.
Push-ups or planks on flat hands with the thumb spread	Weight through a spread thumb stresses the ligament (our reasoning).	Fists or push-up handles with the thumb tucked, once your team allows.
Hanging from a bar and heavy grip work early on	Heavy gripping waits until about weeks 9 to 12 in one NHS trust's protocol.	Light grip work in stage 3.Try: Ball squeeze
Tight ski pole straps, or gripping the pole as you fall	The pole levers the thumb outwards when the hand hits the snow.	Let the pole go as you fall.
Ball sports without protection in the first weeks back	Experts advise protecting the thumb when you return to sport.	Tape or a splint for sport at first.

Routines to follow

Wrist and forearm routine

Wrist mobility and forearm strength for desk work, climbing, push-ups and handstands.

10 minBeginner7 movesA wall, A dumbbell

Grip strength workout: squeezes, curls, carries and hangs

A 20-minute grip session: warm up the wrists and fingers, train the hand and forearm muscles, then carry and hang to load your grip the way everyday life does.

20 minBeginner10 movesOther / check instructions, A band

Ski warm-up

A 7-minute warm-up for the top of the slope with your boots on: a march, arm and hip circles, leg swings, trunk turns and wrist circles, then your stance.

7 minBeginner10 movesA wall

Ski fitness workout

A 40-minute pre-season workout for skiers and snowboarders: squats, split squats, single-leg hinges, side-to-side strength, landings and balance.

40 minIntermediate17 movesA wall, A dumbbell

More moves for this area

Questions people ask

What is skier's thumb?

A sprain or tear of the ligament on the index-finger side of the thumb's knuckle, when the thumb is forced away from the hand. It is named after falls while holding a ski pole, but it also happens in ball sports and falls.

How do I know if the ligament is torn?

Pain, swelling and bruising at the base of the thumb on the index-finger side, a weak or painful pinch, and sometimes a loose feeling or a lump. Only an examination by a trained clinician can tell a sprain from a complete tear, so get it checked within days.

Do I need surgery?

Not for a sprain or a partial tear, which heal in a splint. For a complete tear, UK guidance says early surgery or a cast or rigid splint are both reasonable, on very limited evidence, decided with a specialist within 2 weeks of referral. Most surgeons operate when they think the torn end is trapped or a bone fragment has moved, though no test reliably shows a trapped ligament.

What is a Stener lesion?

It's when the torn end of the ligament flips outside a sheet of thumb muscle, so it can't reach the bone to heal by itself. How often it happens varies widely between studies, and no test reliably shows it.

How long does skier's thumb take to heal?

Often a splint or cast for about 4 to 6 weeks, then exercises, and NHS protocols expect full grip and sport from about 9 to 12 weeks. Full recovery can take 3 to 6 months, and your hand therapist sets the timings.

How long will I wear a splint?

Usually about 6 weeks, sometimes 4, after a sprain or a tear treated without surgery. After surgery, a cast for 2 to 4 weeks and then a removable splint. Wear it exactly as your hand therapist says.

Do I need an ultrasound or MRI?

Not routinely. X-rays are needed, and ultrasound or MRI can help when the examination is unclear, but neither is reliable enough to decide on its own.

What exercises help?

At first, moving the fingers, wrist, elbow and shoulder, and the tip of the thumb in the splint; then gentle thumb movement in every direction; then grip and pinch strengthening. Avoid pushing the thumb outwards and heavy pinching until your therapist says otherwise.

When can I ski or play sport again?

Usually from about 9 to 12 weeks, when your team agrees, with the thumb protected by a splint or tape at first. After surgery, 98% of athletes in one review returned to their sport.

What happens if it isn't treated?

A complete tear that doesn't heal can leave a loose, weak and painful thumb and raise the risk of arthritis. Late repairs may need a tendon graft and do less well: 81% of thumbs were stable after a graft, against 95% after an earlier repair.

What's the difference between skier's thumb and gamekeeper's thumb?

It's the same ligament. Gamekeeper's thumb first described the ligament stretching slowly over years; skier's thumb is the sudden injury.

How can skiers prevent it?

Let go of the pole as you fall. Pole grips with a protective bow once helped but are no longer made, and quick-release straps or gloves with thumb supports haven't been tested.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.