A sprain is an injury to a ligament, which is a soft tissue that connects bones to each other across joints.
When the thumb is bent out of it's normal range of movement (usually backwards), damage occurs to the ligaments supporting the joint at the bottom of the thumb (metacarpo-phalangeal joint). It is common in skiing, bowling, gaelic football, volley ball and from a fall into the thumb, forcing it backwards.
The most common ligament to be injured in the thumb is the ulnar collateral ligament (UCL). This helps connect the thumb to the hand near the thumb and finger web space. This ligament is very strong and it allows the thumb to act like a stable post. Injury to this ligament is sometimes called “skier’s thumb†because it is a common injury from falling while holding a ski pole.
The radial collateral ligament is on the other side of the thumb. It is mostly used during pinching actions.
Damage to either ligament can result in instability in the thumb which if not addressed can lead to degenerative changes in the thumb joint.
Characteristic signs include pain, swelling, and bruising around the thumb , and especially over the joint of the thumb which is nearest the web space. The thumb will feel very weak and it is difficult, or in most cases, too painful to grasp objects or perform actions such as tying shoes or turning a key.
Other symptoms include intense pain experienced if the thumb is caught on an object, such as when reaching into a hand bag or into jeans pockets.
Usually the description of how the injury happened and where the pain in experienced can help to identify an injury to the thumb ligaments.
However, it is always best to check that there are no
a fractures to the thumb bones by having an x-ray.
A partial strain that does not require surgery can be treated with a thumb spica splint for four to six weeks. Controlled exercise may be started at three to four weeks, with gradual return to full activity. Radial collateral ligament injuries are also treated this way.
The end of a completely torn ulnar collateral ligament often gets trapped behind a tendon. This "trapping" of the ligament is known as a Stener Lesion. Complete ulnar collateral ligament tears are most commonly treated with surgery to repair the ligament.
Sometimes when the ligament is being repaired the surgeon will see that the remaining ligament tissue is of poor quality and the ligament must be reconstructed with a tendon or ligament graft.
Untreated tears to the UCL can cause persistent instability of the thumb.
Please note:
If you have had arm or hand surgery please telephone to discuss this before attending Hand Kinetics. It is always helpful to bring any reports you may have if you recently attended hospital for your hand or arm condition.
If you have had surgery a cast will have been placed on your thumb, wrist and forearm for approximately 4 weeks. Your thumb tip and your fingers are left free.
After the cast is removed you can be fitted with a removable splint that is very similar in size and shape to your cast. However you can remove this splint for gently graded exercises and range of motion.
At first you will remove the splint only under the supervision of the Hand therapist. As you progress you will be instructed by the therapist to remove the splint in controlled situations at home for exercise. It still takes another month at least before you can use your hand without limits or splinting. Some take longer, others go faster, but overall you have to consider it to be a 2 -3 month process.
Failure to wear a cast, and then a splint and deciding not to go to therapy can limit or compromise your result. In general some loss of motion of the thumb occurs but the goal is to have a stable thumb joint for activity.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
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