Common upper limb injuries in skiing and snowboarding

Reviewed By Doctors of Asia Medical Specialists

(Last updated on: January 21st  2021) 

Recently, Hong Kong has loosened its COVID pandemic restrictions for travellers returning to the city. Many Hong Kong residents have longed for overseas travel over the last 3 years. 

Many people are taking ski trips with the upcoming Christmas and Chinese New Year holidays. However, popular winter sports like skiing and snowboarding are associated with a high number of orthopaedic injuries in the upper limb.

What are the common injuries in skiing and snowboarding?

Upper limb injuries account for 20% of all injuries in skiers and snowboarders. Common injuries include wrist fractures, forearm fractures, clavicle fractures, thumb ligament injuries, shoulder dislocations and elbow dislocations. A survey conducted in Japan interviewed 6,837 injured snowboarders and 2,175 injured skiers. Of these, 40% of snowboarders and 16.6% of skiers suffered fractures or dislocations in the upper extremities.  

Common upper limb injuries in skiing and snowboarding

The most frequent fracture sites in snowboarders are wrist fractures, which account for 62% of all fractures. For skiers, the most common fracture site is the clavicle. Elbow and shoulder dislocation are typical injuries for both sports. However, dislocations are more common in snowboarders compared to skiers. Studies from both USA and Japan found snowboarders have a significantly higher ratio of upper limb injuries compared to skiers, especially in the case of wrist and forearm fractures. The main explanation found was that 93% of snowboarders did not receive any formal lessons or training from professional instructors.  

Wrist fractures

Wrist fracture results from falling on an outstretched hand. The patient will typically notice wrist pain, swelling, bruising, or even wrist deformity. In severe cases, the fracture could cause damage to the nerves and blood vessels in the wrist.

Diagnosis is usually made with simple x-rays of the injured wrist. A fracture would be preliminarily treated with a temporary cast or splint, ice therapy, elevation and an arm sling. Afterwards, your orthopaedic doctor would advise on the final treatment: cast or surgery. The cast is usually kept for 6 weeks for the bone to heal. After 6 weeks, the cast is removed, and physiotherapy starts to move the wrist and gradually build up its strength of the wrist. For patients who require surgery, the wound usually heals within 2 weeks, and physiotherapy can start immediately after surgery. The fracture usually takes 6-8 weeks for both treatments to heal. The patient can usually resume sporting activities after completing physiotherapy, approximately 3 to 4 months after injury.

Forearm fractures

Another common fracture found in snowboarding and skiing is the forearm fracture. These tend to occur in younger patients aged 10-20 years old. This fracture results from a direct blow (hit) against the forearm.  This can also associate with dislocation of the elbow and wrist joints.

Like wrist fractures, the patient will complain of pain, swelling, bruising or deformity at the site of the fracture.  If the nearby joints, like the elbow and wrist, are dislocated, the patient cannot move those joints, and the pain is severe. It is important to see the doctor immediately for assessment and diagnosis with x-rays.

The initial treatments are ice therapy, elevation and cast. Most of the time, forearm fractures will need surgery. Immediately after surgery, gentle physiotherapy will be started. Patients can resume sports after the bone is healed and physiotherapy is completed.

Clavicle fractures

The clavicle, aka the collarbone, is one of the most commonly fractured bones in the body and is the most frequent upper body fracture in skiing. This is caused by colliding with others or falling heavily onto an outstretched hand. The impact of the fall is absorbed by the hand and the force travels up to the clavicle to cause a fracture if the impact is strong enough. 

If the clavicle is fractured, the shoulder will be swollen, painful, and bruised. The clavicle may be misshapen, and fracture fragments may tent up the skin. Diagnosis is made on x-rays.

Unless the fracture is severe, most healed by wearing a sling or a figure of 8 bandage for 4-6 weeks, during which time you should keep the shoulder completely immobilized and not be able to ski. A physiotherapist will help you to strengthen and exercise the shoulder passively until it is completely healed. Suppose the fracture is badly displaced or shortened. In that case, surgery is required, especially if there are complications such as damage to the nerves and blood vessels caused by the fracture. Most of the time, clavicle fractures usually heal well on their own.

Skier's Thumb

Skier's Thumb is an indirect injury to the base of the Thumb caused by the ski poles during a fall. This type of injury affects skiers more than other sportsmen and women. It happens when skiers fall with the ski pole still in hand, and the handle of the pole causes the Thumb to be stretched out, tearing or stretching the ligament of the Thumb. When the Thumb is bent backwards by a large force, the UCL (ulna collateral ligament) of the Thumb can be sprained or torn. UCL joins the base of the Thumb to the wrist and is vulnerable to injury.

Patients will find the base of the Thumb swollen, bruised and painful. After a couple of days, the joint may feel unstable, so the patient may have difficulty gripping things between the Thumb and index finger.

Suppose the UCL is sprained or partially ruptured. In that case, it can be treated conservatively with ice, anti-inflammatory drugs and a splint. A tailor-made splint keeps the Thumb in the correct position whilst the ligament heals. The healing process usually takes 4-6 weeks. Afterwards, physiotherapy exercise work on regaining the Thumb's range of movement and strength. If the UCL is completely ruptured, surgery may be an option. Following the operation, the Thumb will be put in plaster for 6 weeks, followed by physiotherapy.

How Can You Prevent Skier's Thumb?

Wearing tape or a thumb brace will help to protect it from damage. Your best advice is to learn to hold your pole straps properly. This will help you to keep the pole in the correct position and lessen the chances of it indirectly causing damage to your Thumb. Also, to minimize the chance of injury, drop your ski pole during all falls. Thus, choose to use poles with finger-groove grips instead of wrist straps to make discarding your poles easier.

5 tips to avoid skiing or snowboarding injuries!

- Get lessons from a proper instructor

- Ski or snowboard in the run within your skill levels

- Avoid skiing/snowboarding in bad weather conditions

- Avoid skiing/snowboarding on unfamiliar terrain or off-pist

- Ski/snowboard during less busy times to minimize the risk of collision with other others