HAND & WRIST
The first reaction to a fall is often to try and catch yourself with an outstretched hand. This sends forces through your hand and wrist with injuries dependent on the position of your fingers and angle of your wrist. If skiing, your pole may hit the snow or ice first which exposes you to a different set of risks, especially if the strap gets caught around your hand. Ligament injuries occur when the force opens up a joint, which when extreme can also lead to joint dislocation. Fractures occur when direct or rotational forces are transmitted through the bone.Other injuries in the hand and wrist area can be from a repetitive new action, for example when quickly alternating your planted pole when skiing.
SKIER’S THUMB
An injury doesn’t have a name like this unless this is commonly seen during skiing! The thumb is forced out to the side putting pressure on the inside ligament – the ulnar collateral ligament (UCL). You are more susceptible to this if you have tight pole straps or you keep grabbing the pole when falling. The ligament can be sprained and go on to heal well in a specialist immobilisation splint. If the ligament is fully ruptured then it can result in long-standing instability and a restriction in function. Therefore, surgical repair or a later reconstruction may be required.
WRIST FRACTURES
These are a common injury for skiers and snowboarders, the distal radius and ulna styloid can fracture and lead to significant displacement. Snowboarders are more likely to fracture their wrists because the natural position to fall is with your arms stretched out. The initial emergency medical treatment will be in the medical centre where pain relief is given and a manipulation performed. A temporary slab of cast plaster is then used to hold the position of the broken bones. X-rays before and after manipulation will help guide future management. If the broken bone has perforated through the skin an emergency operation is required. If the manipulation is not acceptable or the position slips then future surgery is likely required when you return to the UK.
SCAPHOID FRACTURES
This is the bone that makes up a large part of the far side of the wrist joint. Fractures here can also be displaced and only improved with surgery. The blood supply to this bone is often sensitive to fractures making treatment more complex with either a longer period in cast or surgery to fix the fracture with an internal screw. There are 8 small bones in the wrist (the carpus) and each can fracture with bone-specific treatments required. Fractures can be associated with dislocations of the carpus.
FINGER FRACTURES
Like in the wrist, finger fractures can often be manipulated. Once in an acceptable position, immobilisation is with strapping to the neighbour fingers and a splint or temporary slab of plaster. It is important that the fracture does not heal with a rotational deformity and this often needs to be confirmed to ensure non-operative management is correct.
DISLOCATIONS
Dislocations can occur during snow sports when you fall and put your hands out for protection. These are most commonly in the joints of the fingers and need to be reduced back into place and splinted. Swelling and subsequent stiffness in the joint are the main longer-term issues and specialist hand therapy can minimise these.
OTHER LIGAMENT INJURIES
There are multiple ligaments in the front and back of the hand and wrist with ruptures specific to the direction of force. If there is significant ligament damage then dislocation or joint instability can be seen on x-rays.
TENOSYNOVITIS
This is a repetitive, overuse injury. There are tendons passing in the forearm and down towards the thumb, crossing the wrist. During snow sports you may be exposed to new movements that cause inflammation of the tendons and their surrounding sheaths. Resting splints and anti-inflammatory medications or injections may be required.
Keep in mind that early interventions will influence the speed of recovery.
