Thumb sprain (skier's thumb) or finger sprain

A sprain is also called a strain.

What is a thumb or finger sprain?

A sprain of the thumb or finger is a stretching or tearing of one or more ligaments—the tissues that connect bones. It can cause swelling and a bruise, which is discoloration under the skin. Bleeding around the injury can contribute to the bruise.

The middle finger joint is the junction between two bones in the finger. It can also become dislocated: when this happens, the bones shift out of their normal position. Dislocation toward the back of the hand is the most common type of finger dislocation.¹

What is a ligament?

A ligament connects bones and helps stabilize a joint. The body contains many ligaments that limit certain movements while still allowing movement.

In the finger, the collateral ligaments are located on either side of the joint. They stabilize the joint against side-to-side movement.^{2, 3}

What is skier's thumb?

Skiers’ thumb is an injury to the ulnar collateral ligament, located on the side of the thumb facing the index finger, at the joint where the thumb meets the hand. Forced abduction of the thumb, sometimes accompanied by a backward movement, can stretch or tear this ligament.⁴ A fall in which the hand is attached to the ski pole by the wrist strap—the strap wrapped around the wrist—can cause this movement. Explanations of thumb sprains describe this mechanism as it occurs in skiing.

What is the function of the palmar lamina of the finger?

The palmar plate is a strip of tissue located on the palm side, in front of the middle finger joint. It limits excessive backward movement and contributes to stability.^{2, 5} An injury may also be accompanied by a fracture—a broken bone—which an X-ray can help detect.⁶

What are the causes of a thumb or finger sprain?

A sprain of the thumb or finger usually occurs after a fall, a blow, or a twisting motion that strains the joint. The ligament in the thumb can also be injured gradually by repeated gripping or twisting motions, as described bythe American Academy of Orthopaedic Surgeons.

Common causes of thumb or finger sprains are:

• Falling on your hand
• Rapid and sudden twisting of the thumb or a finger
• A direct blow to the thumb or finger

Therefore, gradually developing pain alone is not enough to rule out a ligament injury. Other causes are possible, such as damage to a tendon—the tissue that transmits force from a muscle to a bone. An evaluation helps distinguish between them.

What kinds of accidents can injure the thumb or a finger?

• In skiing, when the pole gets stuck in the snow (skier's thumb)
• In volleyball, when blocking a ball attack
• When slipping and falling on the thumb or finger

Dislocations and ligament tears in the fingers are common hand injuries among athletes. Some injuries also involve a tendon. Treatment depends in part on the stability of the joint after it has been reset by a professional.³

What are the symptoms of a thumb or finger sprain?

Symptoms of a sprained thumb or finger include pain, swelling, bruising, and difficulty using the hand. The presence and severity of these symptoms vary depending on the injury.

The main symptoms are:

• Pain in the injured thumb or finger
• Often there is swelling in the thumb or finger
• There may be bruising on the thumb or finger

What actions can make the pain worse?

• Thumb or finger movements
• Putting weight on the hand (for example, to get out of bed)
• Lifting loads (grocery bags, a pot full of water, for example)
• Forcing with the hand (opening a jar or twisting a towel, for example)

How to diagnose a thumb or finger sprain?

The diagnosis of a thumb or finger sprain is based on the circumstances of the injury and an examination of pain, range of motion, and joint stability. An X-ray may be taken to check for a fracture; the doctor may order additional imaging tests if necessary.⁴

If you experience pain, swelling, or bruising in your thumb or finger after an injury, or if you have difficulty moving it, seek medical attention immediately. It can be difficult to distinguish between a severe sprain, a dislocation, and a fracture without an X-ray. You should seek medical attention if you experience any of the following symptoms:

• Significant swelling of the thumb or finger
• Visible deformity of the thumb or finger: Go to the emergency room

Also go to the emergency room if your finger or thumb turns blue, feels numb, or has a wound where you can see bone after an injury. These signs do not all need to be present at the same time. Do not try to put a dislocated joint back in place yourself. The NHS’s guidance on finger and thumb injuries details these emergency situations. If the wrist has also been injured, a study of 391 adults evaluated a model combining deformity, swelling, and pain during forearm rotation.⁷ This model applies to the wrist, not to an injured finger alone.

In Quebec, a physical therapist who holds the required certification may order an X-ray for an injury to muscles, bones, or joints that occurred less than 72 hours ago. The physical therapist must be the first professional to evaluate you for this injury, prior to a medical consultation. The regulations of the Ordre professionnel de la physiothérapie du Québec govern this prescription. This option must not delay the urgent care described above.

Pain near the base of the thumb after a fall may also be caused by a fracture of the scaphoid, a small bone in the wrist. Blood supply to this bone, the position of the bone fragments, and a delayed diagnosis can complicate treatment.^{8, 9} Have persistent pain after a fall evaluated promptly, even if it feels like a sprain.

A finger dislocation may also be accompanied by a fracture or ligament injury. An injury that is misdiagnosed can leave the joint unstable, deformed, or stiff. Prompt diagnosis and treatment reduce the risk of overlooking an injury that requires special care or surgery.¹⁰

When to consult a physiotherapist for a thumb or finger sprain?

You can see a physical therapist for pain, stiffness, or weakness that limits the use of your thumb or finger after a sprain. A swollen, bruised, or numb injury requires the emergency care described above first.

You can see a physical therapist directly, without a doctor's referral. The physical therapist will take into account any previous examinations and instructions you've received and refer you to a doctor if your injury requires it.

What are the physiotherapy treatments for a thumb or finger sprain?

Physical therapy for a sprained thumb or finger combines appropriate protection, exercises, and a gradual return to activities. The program aims to restore movement, strength, and function of the hand, depending on the stability of the joint and medical recommendations.

It takes time for a ligament to heal. Inflammation is part of the body’s response to injury, but the level of protection needed depends on the severity of the injury. A sprained thumb may require a splint, a device that limits certain movements. A complete tear may require surgery. Treatment is chosen based on the extent of the ligament injury.

A 1997 review reported short-term benefits of anti-inflammatory drugs, but also noted conflicting clinical results and reservations regarding long-term tissue repair.¹¹ Ask your pharmacist or doctor which medication is right for your situation. Do not change a prescribed treatment based solely on this article.

The physical therapist also identifies what is limiting your return to activities and adapts the program to your progress.

What factors might make it difficult to resume operations?

• Exercises or tasks that are too challenging at this point, or a return to activity that is too limited
• Ways of moving your hand that irritate the injury while it heals
• Stiffness in the joints or muscles, or symptoms that suggest nerve irritation
• Worries or fears related to the injury or pain

Your physical therapist will help you choose the right movements and activities. He or she will monitor the progression of your symptoms and adjust the exercises based on your progress and the necessary precautions.

Healing can be compared to caring for a plant: pulling on it won’t make it grow any faster. You can make sure it gets enough water, sunlight, and fertilizer. When it comes to an injury, the idea is to promote conditions conducive to recovery, without promising the same recovery time for everyone.

Your physical therapist assesses the problems with your hand and the severity of the injury based on the following factors:

• Possible movements in your joints
• How you feel and how your symptoms respond to movement, if nerve irritation is suspected
• The quality of your movements
• Your strength and stability

How does the treatment fit your thumb or finger?

Treatment is tailored to the injury, its stability, and the stage of recovery. Your physical therapist may recommend the following interventions once movement is permitted:

• Mobilization techniques—gentle movements performed by the physical therapist’s hands—for a stiff thumb, finger, or wrist joint
• Exercises to restore strength and control of the thumb, fingers, and the entire hand
• Tips for adjusting the duration and intensity of your work and leisure activities
• Tips for modifying a movement that aggravates an injury
• Taping—using adhesive tape—to support a finger when this type of protection is appropriate for the injury

A study compared an elastic bandage, a bandage that connected the injured finger to the adjacent finger, and a splint. The 175 participants, aged 5 to 60, had various finger sprains or fractures that were treated without surgery. The elastic bandage resulted in better range of motion and fewer difficulties with daily activities than the splint at three weeks and three months, as well as better grip strength at three months. The authors also reported less nighttime pain. Thumb injuries accounted for 13% of the group, but their results were not presented separately.¹² The choice of support therefore depends on the specific nature of your injury. An elastic bandage is not a substitute for a prescribed splint or necessary surgery.

What to do at home for a thumb or finger sprain?

Home care includes protecting the thumb or finger, adapting your daily activities, and gradually resuming permitted movements. The PEACE and LOVE principles provide guidelines that can be adapted to your injury. Our article on PEACE and LOVE explains this mnemonic.

PEACE and LOVE advice specific to the thumb and fingers

PEACE and LOVE’s recommendations for the thumb and fingers include proper compression, resuming light activities, and engaging in general activity within comfortable limits. A fracture, severe tear, or surgery may change these recommendations; follow the protective instructions you have been given.

C for compression: protect without squeezing too tightly

A compression bandage or tape may be applied to the thumb or finger if this type of protection is deemed appropriate. Ask how to apply it. It should not be so tight that it causes numbness or a change in color. Remove your rings if you can before your hand swells any further. If the finger remains blue or numb after loosening the bandage, seek urgent medical care.

L for Load: Gradually Resume Tasks

Resume normal hand movements and use once your healthcare provider gives you the go-ahead, provided there is no significant increase in pain. You can start with light objects or dishes if these activities are permitted. Continue wearing a splint as directed; with some thumb sprains, you should avoid gripping or applying force while the splint is in place.

V for Vascularization: Maintain a Tolerable Level of Overall Activity

In this guide, “vascularization” refers to the supply of blood to tissues. The authors of PEACE and LOVE suggest an activity that exercises the heart without causing pain at the injury site. It allows you to stay active during recovery, though it does not guarantee faster healing of the thumb or finger ligament. A review reports faster recovery with early mobilization rather than prolonged rest after an ankle sprain.¹³ This finding pertains to movement of the injured ankle. For the hand, choose an activity that is compatible with protection and permitted movements:

• Walking
• Riding a stationary bike without painful support or using an illegal grip with an injured hand
• Run if you don't have pain
• You can swim without pain only if your movements are unrestricted and you don't have a splint that needs to stay dry
• Engage in another activity that increases your heart rate without worsening the pain or conflicting with safety guidelines

Sources

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11. Hertel, J. "The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries." J Athl Train. 1997;32(4):350-8. (Back to section: 1)
12. Kilinc BE, Arikan HI, Gultekin O, Varol A, Ondur B, Oc Y. Beyond the splint: efficacy and safety of Kinesio taping for the non-surgical management of finger injuries. BMC Musculoskeletal Disorders. 2025;26(1):767. (Back to section: 1)
13. Tiemstra JD. Update on acute ankle sprains. Am Fam Physician. 2012;85(12):1170-6. (Back to section: 1)
14. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73.