Dislocated Thumb

A forceful trauma (falls or sports injury) to any of the figure joints can result in finger dislocation. The thumb consists of only two joints, whereas the other four fingers consist of three joints, which allow it to bend forwards, downwards, and sideways. These two thumb joints are the interphalangeal joint (which is located closest to the fingernails) and the metacarpophalangeal joint (located at the base of the thumb).

Thumb dislocations are usually caused by bending the thumb backwards beyond its normal range. They are the most common type of hand injuries that happen to athletes playing football and basketball whilst catching or blocking the fast-moving ball. Although a thumb dislocation is not a medical emergency, delaying its treatment might increase the swelling in the finger, making the treatment difficult.

Other symptoms linked to dislocated thumb include the following:

• Sharp pain around the thumb
• Limited movement
• Swelling and bruising
• Tenderness
• Dorsal deformity
• Numbness and discomfort when moved
• Changes in color

While anyone can experience a dislocated thumb, here are certain risk factors for thumb dislocations:

• Heredity – Some patients are born with ligaments that are looser and more prone to injury than those of other people.
• Sports – Many dislocations occur during high-impact or contact sports, such as gymnastics, wrestling, basketball, and football.
• Susceptibility to falls – Falling increases the chances of a dislocated thumb if you use your hands for impact or if you land on a surface.

Generally, while painful and distressing, a dislocated finger is not a life-threatening emergency. However, it is important to seek medical attention if this occurs. A person should not attempt to relocate the dislocated finger themselves. Manipulating the injured finger can cause additional damage to the joint or the surrounding structures.

Finger dislocations can damage many structures within the finger, including the joint surfaces of the bone, the volar plate (a thickened ligament that helps stabilize the palm side of the joint), ligaments, and tendons. Acute complications include the inability to reduce dislocation and associated fractures. These may require surgery to repair the finger (such as the thumb).

Other long-term complications can include chronic stiffness, swelling, pain, and recurrent dislocation of the injured joint. Boutonniere deformity is a complication of dorsal dislocation of the PIP joint with tendon damage and subsequent scarring that causes the PIP joint to be held in permanent flexion. Mallet deformity can occur with a dislocated DIP joint with associated tendon rupture that causes the tip of the finger to droop and not completely straighten.

The diagnosis begins with a history of how the injury occurred, and the patient usually knows which joint is injured and cannot move it appropriately. Upon physical examination, it is possible to feel and see the finger deformity.

The exam may also want to focus on the rest of the hand to be sure there are no other associated injuries that might be missed. Also, a healthcare provider will want to assess the nerve function of the finger beyond the dislocation, since nerve injury is one of the complications of a thumb dislocation.

Medical professionals typically take X-rays of the finger to confirm the dislocation and also to look for associated fractures of the bones of the finger that might make a reduction of the dislocation difficult or cause complications later during recovery. X-rays of the injured finger are important in children since growth plate fractures are more likely to occur than a joint dislocation.

In most cases, if your thumb dislocation is not severe, the doctor can immediately fix it by externally manipulating and putting your bone back in its original position. This is known as a closed reduction.

Before they proceed to do this, you might get a local anesthetic medication to numb your thumb and an analgesic to ease your pain afterward. During the procedure, the doctor will gently restore your thumb to its correct position by gently pushing or pulling it. The procedure will vary depending upon which of the two joints (interphalangeal and metacarpophalangeal) are dislocated. The doctor will then perform another X-ray to confirm the success of the reduction procedure.

Once your thumb is back in its normal position, it will be wrapped in a splint or cast for 3-6 weeks. Your doctor will once again use an X-ray of your thumb to confirm the restoration of your thumb joint to its normal position.

Your doctor will teach you some exercises to be performed at home to restore the normal strength and range of motion in your thumb. If you continue to have severe thumb pain after closed reduction or if your injured thumb is loose and unstable, you may require further surgery to fix your dislocated thumb.

The reduction is performed by opening your thumb, and the method is known as open reduction. The duration of a dislocated thumb recovery depends on the damage sustained to the joints and ligaments. Some dislocated thumb injuries take 1-2 weeks of healing time, while some patients take 6 weeks for a full recovery.

While waiting for a complete recovery, it is recommended to understand the right and wrong to speed up the healing process; here are a few ways to prevent recurrences of dislocating your thumb:

• Avoid hot baths and / or hot compresses.
• Avoid excessive alcohol consumption.
• Avoid running or extreme exercises to prevent additional injury.

If you’re dealing with a mild thumb injury, doing thumb rehab exercises can help promote blood flow and increase the range of motion through your thumb joint. Here are some thumb exercises you can try, including the following:

Rubber ball exercise

This type of hand exercise helps strengthen your thumb, and entire hand. Firstly, hold a small rubber ball; one that is small enough to fit into your palm. Then, grasp your fingers around it and squeeze the ball as tightly as possible. Lastly, hold this position for 5 seconds before repeating for 2 sets of 15 repetitions a day.

Object pick-up

Pick up a variety of small objects, such as paper clips, safety pins, pencils, coins and, marbles, using your thumb and each of your other fingers, one at a time for 5 minutes a day.

Range of motion thumb exercise

This thumb exercise helps increase the function and movement of your affected hand. First, lay your hand down flat on a table and stretch your thumb away from your palm as far as you can. Finally, hold this position for 5 seconds, then return to the starting position. Next, lift your hand slightly off the table in a handshake position and stretch your thumb away from your palm as far as possible.

Hold this position for 5 seconds and then return to the starting position once again. Stretch your thumb across your palm toward your pinky finger and hold this position for 5 seconds. Return to the starting position, repeating this exercise with 2 sets of 15 repetitions a day.

Range of motion wrist exercise

Treatment for a thumb injury can often mean time spent in a cast or splint that restricts the range of motion and functioning of your wrist, therefore, this can leave your wrist weak and stiff. This exercise can help improve the strength and function in your wrist and into the base of your thumb.

Begin by placing the elbow of your affected thumb on a table or other flat surface. Afterwards, gently bend your wrist forward and hold for 5 seconds. Complete this method with 2 sets of 15 repetitions. Next, gently bend your wrist backward and hold this position for 5 seconds. Gently move your wrist from side to side, as if you are giving a handshake, and hold for 5 seconds in each direction. Repeat this exercise twice a day.

Most at-home treatment includes methods such as rest, elevations, and splinting the thumb, as described below:

Elevation

Keep your arm elevated to reduce pain and swelling. When sitting or lying down, raise your arm above the level of your heart. You can do this by placing your arm on a pillow that rests on your chest, or you can place your arm on a pillow at your side. This is most important during the first 48 hours after injury.

Ice application

Apply an ice pack over the injured area for no more than 20 minutes. You can apply this every 3-6 hours for the first 24-48 hours. To make an ice pack, place ice cubes in a sealed, zip-lock plastic bag, then wrap them in a thin, clean towel or cloth. Do not put ice or an ice pack directly on your skin. As the ice melts, be careful that the tape, gauze, cast, or splint does not get wet. Afterward, continue to use an ice pack as needed to ease pain and swelling.

Supportive equipment

Keep the splint or cast dry at all times. Bathe with your splint or cast out of the water, protected with 2 large plastic bags. Then, place 1 bag around the other. If a fiberglass cast or splint gets wet, you can dry it with a hair-dryer in a cool setting.

Pain relievers

You may use over-the-counter medication to manage pain and swelling unless another pain medicine was prescribed.