Obtaining radiographs is imperative, and early orthopedic referral is indicated. Proper poling necessitates passing the hand through the loop of the pole strap and then grasping both the strap and pole in the palm. On physical examination, point tenderness is present over the ulnar aspect of the joint. No laxity indicates a grade 1 sprain. Increased laxity with a firm end point suggests a grade 2 sprain, while increased laxity with no firm end point suggests a complete ligamentous tear, a grade 3 sprain.
Radiographs are necessary to detect an associated fracture.
For grade 1 and 2 sprains, the usual treatment is immobilization in a thumb spica splint or cast with the metacarpophalangeal joint secured in slight flexion for 4 to 6 weeks. The torn ligament ends are unable to reapproximate, and residual instability results. This injury can occur when the skier falls directly on the shoulder. On physical examination, pain is present directly over the acromioclavicular joint, and deformity is seen in grade 2 and 3 sprains. Such injuries can include compression fractures of the body of the lumbar vertebrae or fracture of the coccyx resulting from falls.