Thumb Injuries




Thumb Fractures

A broken thumb is a serious problem. It affects the ability to grasp items. A broken thumb can increase the risk of arthritis later in life.

Anatomy

The thumb has two bones. The first bone (distal phalange) extends from the tip of the thumb to the knuckle. The second bone (proximal phalange) extends from the knuckle to the base of the thumb. This is the area of webbing between the thumb and the first finger. The thumb connects with a bone in the hand (first metacarpal).

Cause

Although a break can occur in any of these bones, the most serious breaks happen near the joints. This is particularly true when the fracture occurs at the base of the thumb near the wrist.

Thumb fractures are usually caused by direct stress, such as from a fall. A thumb fracture may happen when a ball catches and pulls the thumb back. Some fractures may be caused indirectly, from twisting or muscle contractions, as in such contact sports as wrestling, hockey, football, and skiing. People with a history of bone disease or calcium deficiency are especially at risk.

The risk of a thumb fracture can be lessened by using protective taping, padding, or other equipment. Developing strength in the hands through exercise and proper nutrition can also provide some protection.

There are specific types of thumb fractures, depending on the type of break. Bennett and Rolando fractures are breaks at the base of the thumb. They involve the joint between the thumb metacarpal and a specific wrist bone. Fractures that involve the joints are always more difficult to treat and are at increased risk of an unfavorable outcome.

Fractures can also occur in the long portion of the bone called the metacarpal shaft.

Symptoms Diagnosis

A doctor should be consulted as soon as possible. Continued swelling may make it more difficult to align the bones properly. Delayed treatment will make the fracture much more difficult to treat and can lead to a poor outcome. A padded splint can be used to prevent the bone from moving farther out of alignment. This is encouraged before treatment is finalized.

The physician will examine the injury, take a medical history, and order X-rays of the injury.

Treatment

If the bone fragments of the fracture have not moved (displaced) very much, or if the break is located in the middle (shaft) of the bone, an orthopaedic surgeon may be able to use a specially designed cast (spica cast) to hold the bone fragments in place. The cast may need to be worn for at least four to six weeks. During that time, regular X-rays may be needed to ensure that the bone has not slipped out of alignment.

Surgery may be needed, depending on the location of the thumb bone fracture and the amount of movement between the broken fragments of bone. The orthopaedic surgeon may use one of several operative fixation techniques to realign the bone fragments. These fragments must be held in place while the bone heals.

These techniques include devices that hold the bone fragments in place either inside the body (internal fixation) or outside the body (external fixation). Internal fixation techniques include the use of wire, pins, plates, and screws. External fixation techniques include the use of pins in bone that are held in place through their attachment to an external fixation device.

A cast or splint will be worn for two to six weeks after surgery. When the cast is removed, hand therapy may be recommended in order to restore movement. It can take three months or more to regain full use of the hand, depending on the severity of the injury.

Thumb Sprains

What are thumb sprains?

A sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones across a joint.

How do thumb sprains occur?

These types of thumb injuries are common in sports and falls. The thumb is jammed into another player, the ground, or the ball. The thumb may be bent in an extreme position, causing a sprain. The thumb will usually swell and may show bruising. It is usually very painful to move.

What are the most common types of thumb sprains?

The most common ligament to be injured in the thumb is the ulnar collateral ligament. Injury to this ligament is sometimes called “skier’s thumb” because it is a common skiing injury. It occurs when the skier falls and the pole acts as a fulcrum in the hand to bend the thumb in an extreme position. This ligament may also be injured by jamming the thumb on the ground when falling or by jamming the thumb on a ball or other player. The radial collateral ligament may also be injured. It is much less commonly injured than the ulnar collateral ligament.

How are thumb sprains treated?

X-rays are usually taken to make sure the bones of the thumb and hand are not fractured. Your doctor will then examine the thumb to determine whether the ligament is torn. If the ligament is partially torn, it is usually treated in a cast or splint. Radial collateral ligament injuries are frequently treated this way as well. The end of a completely torn ulnar collateral ligament often gets trapped behind a tendon. Complete ulnar collateral ligament tears are most commonly treated with surgery to repair the ligament. Sometimes the remaining ligament tissue is of poor quality and the ligament must be reconstructed.

Chronic Injuries

The term “chronic” refers to an old injury of greater than several weeks duration. In this case, the joint may be unstable with symptoms of pain, especially with pinching. The joint may feel loose and strength may be decreased. These injuries may be treated by reconstruction of the ligament, or joint fusion if arthritis is present.

Associated Injuries

On occasion, fractures may occur along with thumb sprains. These may require additional surgery with repair using metal pins, screws, or plates. Cartilage damage may occur as well which does not show up on x-ray. This occasionally results in long-term pain and eventual arthritis. Some patients may benefit from cortisone injections or eventual surgery.

Information Obtained From National Institute Of Health
Library | Products | Service | Affiliates | Home