• Johnny Sexton – Skier’s Thumb Injury

    PhysioRoom.com examines Johnny Sexton’s thumb injury woes.

    Irish fly-half Johnny Sexton has become more acquainted with a hand splint than a rugby ball this past week after the Fly-half was seen to damage his thumb in Ireland’s Six Nations tie with England at Twickenham on February 22nd.[1] The 28-year old’s Six Nations has been cast with a shadow of doubt as he looks forward to the next game against Italy with a dampened optimism.[2] Sextonֳ injury, known as Skier’s Thumb or, perhaps more interestingly Gamekeeper’s Thumb is usually caused by impact trauma directly to the tip of the digit when falling. As the floor is a regular impact spot in Rugby, injuries such as this are common but usually not career threatening. Though the severity of Sexton’s injury has been reported as low and his return looks promising, Skier’s Thumb is nevertheless a common ailment in contact sports and high impact activities such as its namesake.

    The Injury

    What is it? Either an acute or chronic condition caused by hyper-extension on impact[3] or repeated low grade hyper abduction over time.

    Acute: An acute injury, typically known as Skier’s Thumb, is caused by hyper abduction of the ulnar collateral ligament (UCL) upon impact. This injury occurs when the thumb is pulled away from the palm of the hand and the ligament is over extended. Thumb UCL injuries are traditionally found in skiers upon impact with the ground whilst holding a ski pole. This direct pressure and hyper extension can lead to rupture of the UCL and is common in sports where impact with other participants or the ground is prevalent.[4]

    Chronic: Chronic injuries such as Gamekeeper’s Thumb usually occur through a tear to the UCL from repeated hyper-abduction over a period of time. Gamekeeper’s Thumb derives its name from Scottish Gamekeepers who traditionally apply downward pressure to the neck of a small animal such as a rabbit or fowl when breaking it. Though not an exclusive ailment, the condition is regularly found in those that apply the same hyper-abduction to the UCL ligament over time.[5]


    Partial tear: On occasions where the ligament is only partially torn the patient will simply be required to wear a cast or thumb splint for a number of weeks, depending on the severity of the injury. Johnny Sexton has been noted for wearing a thumb splint over the course of the former week.

    Complete tear: A complete UCL tear may require surgery on the hand to correct the damaged ligament. The operating procedure typically requires the surgeon to open the injury at the site of the thumb and reattach the tendon to the bone by placing anchoring sutures upon it. [6]

    The common operation for Skier’s Thumb is a relatively simple procedure that takes place under general anesthetic.

    Please note: Video not for those with a squeamish disposition!


    Following either a complete tear or during rehabilitation for a partial tear, a variety of different rehabilitation aids may be used to further assist in the healing process. Ice packs and compression at the acute stage of injury should be the first port of call before the severity of the injury is diagnosed.

    In later stages of rehabilitation a number of aids may be employed to further assist in a speedy recovery. PhysioRoom.com stocks a number of hand strengthening devices such as the PhysioRoom.com Hand Grip Exerciser or the industry standard GripMaster product range.

    During the rehabilitation phase it is of high importance to keep the area supported when strengthening methods are not being employed. The inexpensive PhysioRoom.com Thumb Splint with removable metal splint for machine washing and breathable fabric to avoid excess odour is the ideal product for thumb rehabilitation.


    [1] http://www.theguardian.com/sport/2014/feb/27/johnny-sexton-miss-six-nations-thumb-injury-ireland

    [2] www.independent.ie/sport/rugby/six-nations/joe-schmidt-sweating-over-jonathan-sextons-thumb-injury-30040400.html

    [3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654954/

    [4] http://www.methodistorthopedics.com/ulnarcollateral-ligament-injuries-of-the-thumb

    [5] http://en.wikipedia.org/wiki/Gamekeeper%27s_thumb

    [6] http://www.bssh.ac.uk/patients/commonhandconditions/skiersthumb

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