Sports Medicine
Sports Injury Prevention & Rehabilitation

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Sprained Thumb

(Also known as Thumb Sprain, 'Skier's Thumb' )
What is a sprained thumb?
A sprained thumb is a relatively common condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of the thumb.
The thumb comprises of two small bones known as phalanges. These small bones join to each other at the IP joint (Interphalangeal Joint) and to the bone at the thumb side of the palm (1st metacarpal) at the MCP joint (Metacarpophalangeal Joint) forming two joints for the thumb. Each of these joints comprise of strong connective tissue wrapping around the bony ends and cartilage, which lies between the joint surfaces, cushioning the impact of one bone on another during activity.
During certain movements of the thumb, stretching or compression forces are placed on the thumb joints. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint (such as ligaments or joint capsule). When this occurs, the condition is known as a sprained thumb and may affect the IP or MCP joint.

Causes of a sprained thumb
Sprained thumbs are extremely common in ball sports such as basketball or netball and frequently occur due to a specific incident such as a hyperextension force (backward bending of the thumb) or a sideways force. A sprained thumb may also occur in contact sports due to a collision with another player or when tackling, or in martial arts (e.g. blocking a punch or kick with the thumb). A sprained thumb also commonly occurs in skiing when one of the hand poles forces the thumb backwards during an awkward landing or fall.
Occasionally, a sprained thumb may occur due to repetitive strain associated with overuse. This may be the case in patients who perform repetitive activities involving end of range movements of the thumb.

Signs and symptoms of a sprained thumb

Patients with a sprained thumb often experience a sudden onset of thumb pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the front, back or sides of the affected thumb joint. There may be an audible snap or pop sound at the time of injury. Swelling or bruising will often develop around the affected joint. Symptoms are generally exacerbated with activities that involve use of the hand, fingers and thumb such as catching balls, opening jars or doors, writing, picking up heavy objects, general gripping activity, cooking, household activities or placing weight through the affected hand and thumb.
It is also common for patients to experience pain on firmly touching the affected region, and, in some cases, a feeling of weakness in the hand and thumb may also be present. In severe cases, the thumb may be completely dislocated. All dislocations need to be managed by a medical professional and should be X-rayed before and after being put back into place to confirm relocation and to exclude fracture.

Diagnosis of a sprained thumb
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a sprained thumb and to determine the likely structures affected. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis and rule out other injuries (particularly fractures). Generally all traumatic thumb or finger injuries should be X-rayed.

Treatment for a sprained thumb

Most patients with a sprained thumb make a good recovery with appropriate physical therapy. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Protective taping or a protective brace is often required for a period of time to stabilize the joint and protect it from further damage.
Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Treatment of a thumb sprain in the first 48 – 72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following RICE which comprises of rest from aggravating activities, regular icing, the use of a compression bandage and elevation of the affected limb. Anti-inflammatory medication may also be useful in this initial phase of injury and can hasten the healing process by reducing the pain and swelling associated with inflammation.
It is also important for patients with this condition to perform movement and strength exercises early in the rehabilitation process to prevent stiffness and weakness from developing and to ensure the thumb is functioning correctly. These exercises may be limited initially if a period of immobilization is required, however they should generally be implemented as soon as pain allows as guided by the treating physical therapist. A gradual return to activity should occur once the patient is pain free, provided symptoms do not increase. Protective taping or bracing is often required when returning to sport.

Prognosis of a sprained thumb
In cases of a minor to moderate thumb sprain, return to sport or normal activity can usually occur in 2 – 6 weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Physical therapy for a sprained thumb

Physical therapy for a sprained thumb can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • thumb taping
  • thumb bracing
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • ice or heat treatment
  • exercises to improve flexibility and strength
  • education
  • activity modification advice
  • a gradual return to activity program

Other intervention for a sprained thumb
Despite appropriate physical therapy management, a small percentage of patients with a sprained thumb do not improve adequately and require other intervention. Some patients with severe injuries may also require other intervention to ensure an optimal outcome (such as immobilization, splinting or surgery). When this occurs the treating physical therapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, or a review by a hand therapist or specialist who can advise on any procedures that may be appropriate to improve the condition. Occasionally, surgery may be required.