TD asks: My son is an avid skier and about two weeks ago he injured his right thumb. He injured it after falling down during a baseball game. He finished the game, but now he is complaining his thumb hurts and feels “loose” when compared to the other side. He has no numbness or tingling.

He saw his family doctor who advised that he see an orthopaedic doctor even though his X-rays were negative. What do you think may be going on?

Dr. Patel writes: Dear TD, it sounds as though your son may have a ligament injury rather than a bone injury. Even though the X-rays are negative, his thumb ligaments are probably injured.

The classic injury which can occur at the thumb for skiers is called a “Game Keepers Thumb (GKT)”. A GKT is an injury to the ligaments on the side of the thumb. The Ulnar Collateral Ligament is the most commonly injured ligament.

An MRI can help determine if your son has a complete rupture of the ligament. If your son has a partial tear, then the treatment options can include a cast or splint for his thumb while the ligament has an opportunity to heal.

If he has a complete rupture of his ligament, I would recommend he have the ligament repaired. Because he has instability of his thumb, surgical repair would be the best option. Sometimes casting or splinting of the thumb for a complete rupture may work as long as the ligament has not retracted and also there is no muscle interposed along with the ligament. If the ligament is repaired, it still will need to be splinted for four to six weeks to allow for it to heal to the bone.