Pocket Guide: Ski and Snowboard Injuries
read time: 10 minutes
It’s the last run of the last day of Laurie’s epic ski trip with her family. Her husband and kids are already in the lodge, but she had to get a final breath of the crisp Colorado mountain air. As she starts down the mountain, clouds roll in and send the previously glistening snow ahead into a muted flat grey.
She notices a few icy patches have appeared, but it’s still some of the best snow she’s ever skied. As she nears the bottom, the ice patches get bigger and more frequent. At her next right turn, she hears the scrape of the ice and her skis slip violently out from under her. Her bodyweight crashes onto her right side and she stretches out her hand to catch the fall. As she hits the ground, she feels a pop in her inner thumb where she’s gripping her pole…
If ski or snowboard trips are a staple of your winter activities, you’ve likely been in this situation. The day’s going great, your confidence is up, and then out of nowhere a patch of ice or some flat light has you on the ground.
And hurting.
Plenty of bumps and bruises are the ones you shake off and move on from. But what about the ones that are still bothering you at lunch? Or they’re bruised at après ski and it feels really good to hold that cold cocktail glass up against the swelling?
I’ve got you covered. This is a pocket guide to ski and snowboard injuries. Today we’ll run through:
How to do a quick physician’s exam on yourself
What your most likely injury is, based on location (with a quick glance ‘pain map’ of the hand/wrist)
How serious each injury is likely to be
Let’s get to it.
How would a doctor examine my injury?
This isn’t med school, so let’s keep it simple and get you back to your busy day. Here are four basic things you can work through when evaluating an injured finger, hand, or wrist.
Visual inspection - Are there any areas of obvious bruising or swelling? Take note of where the center point of swelling is, especially within those first couple of hours of the injury.
Motion - Can you move the injured joint? Is it painful when you move? Where do you feel the pain when you move (ie, at the injured joint or elsewhere)?
Palpation - This is where the money is. If it’s unclear to you where the center point of your injury is, squeeze or push all over until you find it. It’s ok to give it some force as you pinch. You’ll know you’ve found it because that center point will make you jump in discomfort. We’re not interested in generalized achiness here. We want the primary focused spot where you hurt the most (I promise this is helpful info to collect, even if it hurts!).
X-rays - This is critical to any injury I evaluate in the office. If you have any of the visual signs above, difficulty moving a body part due to pain, or a hot spot of tenderness that makes you lurch in discomfort, be sure you get to a provider who can x-ray your hand/wrist within the next few days. There are no secret substitutes for this.
Predicting injuries based on the location of your pain
Let’s go back to the palpation part I discussed above.
Now remember, multiple areas are likely to be sort of sore after a big crash. But we want that single location that makes you jump out of your chair when pressed (I know, it’s not fun).
In fact, perhaps the highest-yield request I ask of every injured patient is “Point for me with one finger to where it hurts the most.”
Now take that single worst location and plug it into the map below.
This is not an all-inclusive list of every last thing your pain could mean. But it’s probability-based as the most likely serious injury sustained in a certain location. Hopefully, you got off easier than that and just have a low-level sprain or contusion in the area where you hurt.
The potential seriousness of each injury
This is where all the disclaimers have to come in. I am not your doctor and if you are concerned about pain in any of these areas, go see a doctor. Heck, come see me if you’d like. But reading about something on the internet will not save you from missing a potentially serious injury.
Ok, now that that’s out of the way, let’s learn something new.
Boxer’s Fracture - Green Beginner Run
I’ve written about this injury before in-depth, and you can access that article by clicking here. In summary, this injury happens when you punch an object (such as a hard sheet of ice when you fall on the slopes), and it results in a fracture of the 5th metacarpal bone.
This bone can tolerate healing in a significant amount of deformity, often with few functional deficits. You’ll want to have it looked at for x-rays and an examination to make sure your finger won’t heal in a crossed-over position. But other than that, these typically need a cast or brace for only a few weeks before getting things moving with rehab.
TFCC Sprain - Blue Intermediate Run
There are innumerable ligamentous and tendinous structures on the outside of the wrist that are easily injured from the impact of a fall, or the torque of a twisting injury (think ski pole).
But the most commonly injured is this mouthful of a structure called the triangular fibrocartilage complex (TFCC). Say that five times fast.
Think of the TFCC as the trampoline shock absorber of your wrist. It is anchored at many points in the wrist to absorb impacts, and whether from a direct hit or a twisting injury, can be easily sprained.
These injuries are mostly treatable without surgery. But that doesn’t mean they heal quickly. It is not uncommon to have lingering soreness for 4-6 months, often requiring some guided therapy to rehab back to normal.
Distal Radius Fracture - Blue Intermediate Run
This is probably the most common fracture we treat, and in regular terms is known simply as a ‘wrist fracture.’ If you want more than you’d ever care to know, you can read my previous posts here and here.
The radius is one of our two forearm bones and is the most likely bone to break when falling on an outstretched hand (fun fact, we call this a FOOSH for shorthand). The radius typically breaks near where it joins the wrist joint.
These breaks come in many different patterns. If it fractures, but does not move out of place, it does not need surgery (but does need 4-6 weeks in a cast). If it fractures and displaces significantly? Surgery with a plate and screws is your path to restoring function.
Regardless, these all need prompt (within 1 week) evaluation with a hand specialist.
Unless of course, your arm is crooked, bleeding, or numb — please do not wait a week and kindly proceed immediately to the ER.
Thumb UCL Sprain (Skier’s Thumb) - Blue Intermediate Run
As with many of these injuries, I have previous content on ‘Skier’s Thumb’ injuries that you may be interested in here.
Take a look at the pain map above again. Under the blue shading for Skier’s Thumb lies a crucial ligament to hand function known as the thumb ulnar collateral ligament (UCL).
This ligament links the thumb metacarpal bone to the thumb phalanx and, here’s the important part, stabilizes the thumb each time you pinch.
Look at the map and imagine for a moment what would happen while pinching if there were no tether underneath the blue Skier’s Thumb shading. Your thumb would just slide outwards with the force from your index finger. This backstop for pinching is absolutely critical to hand function.
So if you’re bruised, swollen, or feel a lump under this spot after a ski/snowboard fall, don’t delay in seeing a hand surgeon. Partial injuries can be treated in a cast. Complete blowouts of the ligament need surgical repair within 3 weeks to heal most reliably.
Note: This is called ‘Skier’s Thumb’ because of the unique risk ski poles place on this ligament. The ski pole rests right in the web space between the thumb and index finger, placing a huge weighted lever arm just beyond this ligament. It also forces the thumb out and away from the palm, making it more likely to catch on something as you fall (or stick out as you hit the ground). The extra weight plus the additional exposure puts the thumb UCL squarely in the injury crosshairs of any fall while skiing.
Finger Sprain vs Dislocation - SLOW ZONE, proceed with caution
Ugh, these injuries involve such a nuanced discussion that really really requires an x-ray to frame the whole thing. I go deeper into the discussion in a previous post here.
But essentially, these injuries are either really bad or really not. And it’s very difficult to know the difference for sure without said x-ray.
The joint colored yellow in the map above is the proximal interphalangeal or PIP joint. The PIP joint gets sprained all the time, as anybody who plays basketball can tell you.
But as long as it’s just a sprain, you can (and should) immediately start moving it again. Preventing re-injury and regaining your motion is key. However, it’s not uncommon for these to be achy and swollen for 4-6 months. Yep, I said months.
Unfortunately, two much bigger injuries can masquerade as a PIP joint sprain: 1) an unrecognized dislocation with or without fracture, or 2) a tendon rupture (central slip tendon rupture).
Both of these require immediate treatment and many need surgery. Ask any hand surgeon and they can tell you the disheartening stories of finger dislocations that come to our clinics 6 weeks later because “Doc, this finger is still swollen.”
Scaphoid Fracture - Double Black Diamond Expert Run
Speaking of disheartening stories from hand surgeons, these next two will fit right in.
The scaphoid is one of eight tiny little wrist bones known as carpal bones. But this one has perhaps the worst blood supply of any bone in the human body.
Which means, if you break it, the chances of it healing are far lower than any other bone (deeper dive article here). To make matters worse, because the bone is small, a broken scaphoid sometimes just feels like a wrist sprain for a few weeks and many don’t recognize it upfront.
To make matters worse again, the entire architectural support of the wrist rests on the integrity of this bone! So if it breaks and doesn’t heal, your wrist will go down a very predictable path of arthritis known as SNAC wrist (scaphoid nonunion advanced collapse).
There are entire textbooks written about this problem. But suffice it to say — don’t mess around with pain in the shaded area for ‘Scaphoid Fracture’ in the above map (another fun fact: we call this area the ‘anatomic snuffbox.’ I’m not kidding).
Get yourself to a specialist within a week, max.
SL Ligament Injury - Double Black Diamond Expert Run
I could almost copy-paste the above discussion on scaphoid fractures and substitute SL ligament tear. ‘SL’ ligament is short for scapholunate ligament.
This stout soft tissue band links the scaphoid bone to its neighbor, the lunate. Just like scaphoid fractures, this ligament cannot heal on its own when ruptured. And just like scaphoid fractures, this injury often just feels like a moderate wrist sprain for a couple of weeks before improving. And just like scaphoid fractures, the entire architecture of your wrist will collapse over time if this goes unrecognized (this time, we call it SLAC wrist - scapholunate advanced collapse).
So. If your wrist hurts in either of the double black diamond locations above, please do your future self a favor, be overly cautious, and get yourself in front of a specialist who can evaluate your likelihood of serious injury.
Takeaways:
Look for areas of bruising or swelling, and then squeeze around those spots to elicit maximum points of tenderness
Plug these maximum points of tenderness into the hand & wrist injury map provided above
Many injuries from a day on the mountain will be just fine — but beware, a few serious conditions are lurking in the tree wells
My goal is to provide you with more and better information than you started with. No internet article can diagnose your health condition, but you can make informed decisions with the right material.
Most of you will hopefully just file this away for a rainy (snowy?) day. But if you’re actively hurting after a recent injury, be sure to seek prompt evaluation with your physician.
PS. If you found this breakdown helpful, I’d be thrilled if you would consider sharing it via email or on social. It’s support from referral sources like you that help this resource grow!
