What is a dislocated Thumb?
A dislocated Thumb is the medical term used when the ligaments of the thumb (1st phalange) have been injured by being overstretched or torn to the extent that the two connecting bones have become dislodged and are no longer aligned as they should be. The hand itself is made of 3 sections of different bones. The 8 bones at the base of the hand form the wrist; these bones are known as the carpal bones. They form two rows of four cube-like bones that on one side articulate with the radius and ulna bones of the forearm and on the other side articulate with the metacarpal bones. The next section is the mid hand consisting of the 5 long metacarpal bones. The metacarpals connect at the base to the carpal bones and at the front to the thumb and fingers. The thumb and fingers are the last section consisting of 5 bones numbered in the sense that your thumb is 1st and your little pinkie is your 5th. The fingers and thumb are called phalanges and the fingers are individually divided into three parts; there is a distal section (the section under your nail), a middle section and a proximal section (the section that connects to the metatarsals). The thumb differs from the fingers by only having two interconnecting joints as it is missing the proximal interphalangeal joint.
The two joints of a thumb are made up of strong capsules that form around each joint encapsulating it and preventing either boney ends of the interconnecting bones from impacting. The first joint is known as the metacarpal-phalangeal joint (the joint that connects the metacarpals to the phalanges), the second joint connects the proximal phalangeal bone to the distal phalangeal bone and is known as the interphalangeal joint (ip joint). The formation of the joints allows a wide range of movement in flexion and extension. Each joint capsule is filled with a small amount of thick fluid called synovial fluid that acts like a cushion and there is protective layer of articular cartilage that covers each boney surface. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments that surround the joint and are made of thick, tough, fibrous tissue, they overlap the joint and work in co-ordination with the attaching muscles to provide protection and stability for the thumb.
Why & when does a dislocated thumb happen?
Dislocation of the thumb is a relatively common injury and can affect people of all ages they are normally the result of severe impact against a hard object that forces the thumb to bend backwards. It can be a common injury during sports like basketball, hockey, rugby and any wrestling due to direct impact with the ball or component. In-fact any activity of high impact where the thumb hyper-flexes or hyper-extends into an abnormal position with your body weight behind it can result in a dislocated finger. A dislocation injury is very similar to a grade 3 sprain but the trauma sustained is normally a much greater force than that of a sprain.
What does a dislocated thumb feel like?
A dislocated thumb causes a very intense immediate sharp pain around the dislocated joint the pain can radiate up into the back of the hand, down into the palm of the hand and occasionally into the wrist. In some cases a tearing or snapping noise is heard during the injury. The dislocation will be accompanied by intense swelling and bruising and will be incredibly tender to touch. There will be visible joint deformity with the far end of the joint hanging limply. Pain levels will be aggravated by any thumb or hand movements making gripping or lifting objects with the affected hand very painful. In cases where the dislocation is resolved quickly patients can still fully use their thumb with only slight stiffness and a feeling of discomfort when lifting or gripping. The intense pain that some patients experience from a dislocation will last until the joints are reset and will be aggravated or prolonged by any examination or treatment.
What to do if a dislocated thumb is suspected?
Your actions immediately after a dislocation can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol this involve Protection for the thumb by strapping it to the next finger. Rest the hand, try not to use it too much and if you have to then ensure you are not lifting heavy weights. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep the hand raised on a pillow to help limit the swelling.
You should seek medical attention straight away in order to have the joint reset to its proper alignment; your doctor will most likely splint your thumb to the finger next to it in order to provide it with support whilst it heals. It is advisable to follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating exercise movements should be avoided in case of further injury. Massage should be avoided over the first three days after injury as it will also increase any bleeding and swelling.
How long does a dislocated thumb take to heal?
A dislocated thumb can recover in as little as one to two weeks if reset quickly more moderate or severe dislocations take longer, however most dislocations have fully healed within 6 weeks. The after effect of a dislocated joint is that the joint is lax and more prone to injury and you may feel it is always on the point of dislocating even after minor knocks. Recurrent dislocations of the same joint may require surgical intervention although this is rare for the finger/thumb and more commonly used in elbow or shoulder dislocations.
How will a dislocated thumb be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. Your GP may refer you for x-rays or further investigation to rule out the presence of any fractures or other complications.
What treatment options are available for a dislocated thumb?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be initially advised to follow the P.R.I.C.E and H.A.R.M protocols above. A dislocated joint would normally be dealt with by an orthopedic specialist due to the risk of damaging the surrounding arteries or nerves however due to the smaller risk with a thumb your doctor may be able to reset the joints in clinic without referring you to a specialist. After the joints are manipulated and reset a splint will normally be applied where the affected thumb is tethered to the next finger to stabilise and protect it whilst it heals. A dislocated thumb can take anything from 4-6 weeks to heal if not longer for more severe cases. Your Gp or therapist should be able to provide you with exercises to strengthen your hand and finger to aid the healing process and prevent reoccurring injury. Many people find manipulative therapies such as physiotherapy, chiropractic and osteopathy helpful in restoring function to the surrounding joints and providing strengthening exercises. The ice packs used initially will be very helpful during the recovery process when the toe swells after long periods of walking, early in the morning or late in the evening.
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