Ask a Doctor: Thumb Sprains

Ask a Doctor: Thumb Sprains

Hand surgeon Mark Yuhas, MD answers your questions about thumb sprains.

I have a painful thumb joint after an injury. Could this be a sprained thumb?

Yes. A thumb sprain refers to an injury or tear of the thumb joint ligaments. A ligament attaches to bones around a joint to keep it stable. The most common thumb ligament injury is the ulnar collateral ligament (UCL, side of thumb closest to the fingers). The radial collateral ligament (RCL, outside part of thumb) or volar plate (palm side) of the thumb may also be injured. The metacarpophalangeal joint (MCP, joint where the thumb connects to the hand) is most often involved in a thumb sprain.

How do thumb sprains usually occur?

An abnormal bending of the thumb joint typically causes a thumb sprain. The forceful bending can be from the side (classically as in holding a ski pole during a fall) or by a hyperextension (bending back) of the thumb. A fall onto an outstretched hand or a “jammed” thumb, such as during contact from a ball or during sports can result in a thumb sprain.

What are the signs and symptoms of a thumb sprain?

A thumb sprain can cause pain, swelling and bruising of the thumb joint. The thumb might feel loose or unstable.  You might have difficulty turning handles or gripping and pinching objects with the injured thumb.  Elevate and ice the injured hand, and wrap the thumb or use a brace that prevents the thumb from moving until you can be evaluated by a hand surgeon.  This injury is commonly misdiagnosed because the x-ray can look normal even if a ligament is torn.

What should I expect during a hand surgeon’s evaluation?

A typical evaluation starts with a history of the injury and physical examination of the hand and thumb. This will involve a gentle exam to evaluate tenderness, swelling, and stability of the joint. X-rays will likely be used as well to see if there is also a fracture (broken bone).  Sometimes an ultrasound or MRI can help determine further treatment.

What is the treatment for a thumb sprain?

Treatment typically depends on the extent of the ligament tear and whether a fracture of the bone is involved.

Thumb sprains may be treated with a brace, splint or cast that prevents thumb motion.  It usually takes three to six weeks for the ligament to heal like this and then you might be asked to start gentle movement of the thumb.

Surgery may be necessary if it appears that the ligament injury will not heal properly in the injured position.  Surgery involves reattachment of the ligament to the bone. After surgery, the thumb ligament healing process takes about six to eight weeks.

Chronic thumb sprains might involve a ligament injury that cannot be repaired, and your hand surgeon might have to use a tendon (strong tissue that attaches muscle to bone) to stabilize the joint and make a “new ligament.”

Delayed treatment for a thumb sprain can result in weakness with gripping and pinching and continued pain.  Eventually, a chronically unstable joint develops arthritis.

Mark Yuhas, MD is currently a fellow at the Christine M. Kleinert Institute in Louisville, KY, undergoing sub-specialty training in hand and upper extremity surgery. He is Board-eligible in Orthopaedic Surgery and completed his Orthopaedic Surgery residency at the University of Kentucky in Lexington, KY. He will be starting his practice with Wellington Orthopaedic and Sports Medicine in Cincinnati, OH in August 2016. His current special interests include trauma of the hand, wrist, and elbow as well as hand and wrist injuries in athletes.

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