How To Crack Your Own Thumb
Dagny Westall
Thumb arthritis can cause severe pain, swelling, and decreased strength and range of motion, making it difficult to do simple tasks, such as turning doorknobs and opening jars. Treatment generally involves a combination of medication and splints. Severe thumb arthritis might require surgery.
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Your doctor might hold your joint while moving your thumb, with pressure, against your wrist bone. If this movement produces a grinding sound, or causes pain or a gritty feeling, the cartilage has likely worn down, and the bones are rubbing against each other.
If pain relievers and a splint aren't effective, your doctor might recommend injecting a long-acting corticosteroid into your thumb joint. Corticosteroid injections can offer temporary pain relief and reduce inflammation.
These surgeries can all be done on an outpatient basis. After surgery, you can expect to wear a cast or splint over your thumb and wrist for up to six weeks. Once the cast is removed, you might have physical therapy to help you regain hand strength and movement.
A sprained thumb occurs when the ligaments that support the thumb are stretched beyond their limits. This commonly happens when a strong force bends the thumb backward, away from the palm of the hand. The most common way for this to occur is by falling onto an outstretched hand.
Most thumb sprains involve the ulnar collateral ligament (UCL), which is located on the inside of the joint where the thumb meets the palm. An injury to this ligament can be painful and may make your thumb feel loose or unstable. It may also weaken your ability to pinch or grasp objects between your thumb and index finger.
Treatment for a sprained thumb usually involves wearing a splint or cast to keep the thumb from moving while the ligament heals. For more severe sprains or tears of the ligament, surgery may be needed to restore stability to the joint.
The ulnar collateral ligament (UCL) of the thumb is a strong band of tissue running along the inside of the metacarpophalangeal (MCP) joint, which is where the thumb meets the palm. This ligament keeps your thumb stable, especially when you pinch and grasp things.
It is important for your doctor to evaluate even a mild thumb sprain if it does not improve quickly. Proper and prompt diagnosis and treatment of a thumb injury is necessary to avoid long-term complications, including chronic pain, instability, and arthritis.
X-rays. X-rays provide images of dense structures, such as bone. Your doctor may order X-rays of your thumb and hand to ensure that you do not have an avulsion fracture or any broken bones. They may take an X-ray of your uninjured thumb to compare it to the injured thumb.
Your doctor may also order special type of X-ray, called a stress X-ray. During this test, your doctor will apply tension to your thumb while it is being X-rayed to learn more about the stability of the MCP joint. If the test causes pain, you may be given an injection of a local anesthetic.
Other imaging studies. If more information is needed, your doctor may order a magnetic resonance imaging (MRI) scan or an ultrasound. These tests can help your doctor learn more about the severity of your injury and make decisions about your treatment and return to activity.
Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help reduce pain and swelling. If, however, pain and swelling continue for more than 48 hours, see a doctor.
For a moderate sprain, your doctor will probably immobilize your thumb joint with a bandage, thumb spica cast, or splint until it heals. To ease pain and swelling, you can apply a cold pack to your thumb twice a day for 2 to 3 days after the injury. Do not apply ice directly on your skin.
Depending on the severity of the injury, you may be instructed to wear the splint or cast at all times. It is important that you avoid applying any pressure or resistance to your thumb until your doctor says it is OK to do so.
For a severe sprain or tear, you may need surgery to restore the stability of your thumb joint and help you regain function. Surgery involves reconnecting the ligament to the bone and/or repairing the avulsion fracture using a pin, screw, or special bone anchor.
When diagnosed and treated properly, most thumb sprains will heal well with no complications. However, ignoring a sprained thumb with the hope that it will heal on its own may lead to long-term problems, including:
If these late complications develop, you may need surgery to rebuild the ligament using tissue from your upper arm. If there is significant arthritis, you may need a joint fusion procedure to address both the arthritis and the instability of the MCP joint.
As this joint becomes worn, often due to age, it can lead to a painful condition called thumb arthritis (also known as CMC arthritis or basal joint arthritis). Arthritis refers to inflammation in a joint, causing the pain, stiffness, and swelling that makes it so difficult to perform even simple tasks. Thumb arthritis is the second most common type of arthritis in the hand.
There are many different types of arthritis, but the kind that most often affects the thumb is osteoarthritis, the most common form of arthritis. With osteoarthritis, the cartilage inside your joints starts to break down, causing changes in the bone that typically start slowly and worsen over time.
For the physical examination, your doctor will hold the basal joint while rocking your thumb back and forth, Dr. Luo says. If that causes pain or a grinding sound, it means the bones are rubbing directly against each other and likely have thumb arthritis. An X-ray can confirm the diagnosis.
The first method of treatment for thumb arthritis involves wearing a soft brace to limit the movement of your thumb, which allows the joint to rest. If the condition is more serious, a hard brace can be used, and either type can be worn overnight or intermittently throughout the day.
When nonsurgical approaches are no longer effective, surgery is an option. The best type of surgery for you depends on a number of factors, including the progression of the disease and how painful the symptoms are. In most cases, surgery for thumb arthritis involves removing some or part of trapezium (a bone in the thumb joint) with varying ways of stabilizing the joint.
A fall on an outstretched hand with a ski pole in the palm of your hand creates the force necessary to stress the thumb and stretch or tear the ligament. A simple fall on an outstretched hand with an empty palm usually does not create this same force. However, your thumb can also be injured if it jams into packed snow at high velocity.
Another less common cause of this injury is an automobile crash when the driver has the thumb alone draped over the steering wheel. Any injury in which the thumb is abnormally bent backward or to the side can cause skier's thumb.
If you experience any of the symptoms of skier's thumb following an injury, call your doctor as soon as possible. Follow your doctor's instructions about special home care considerations and find out when your thumb can be checked.
If you determine that skier's thumb is possible, considering the way your accident happened, then you should be taken by car to a hospital's emergency department. There is no need to go by ambulance unless that is your only means of transportation or there is another more serious injury associated with the accident.
An alternative to the emergency department would be an office visit to an orthopedic surgeon (bone specialist) or hand surgeon's clinic. If an orthopedic surgeon is available to see you on the day of your injury, it is more efficient to go see the surgeon directly instead of from the emergency department's referral.
If the doctor determines that you have a skier's thumb, then referral to an orthopedic or hand surgeon will be the next step. The orthopedic surgeon will determine when your thumb needs to be reexamined. At that time, your options for surgical versus nonsurgical therapy will be discussed.
If you elect to have surgery, then operative exploration and ligament repair using something called a "suture anchor" will most likely be performed. After the operation, your hand may be placed in a lightweight cast to hold your thumb still while your ligament heals. You will have to remain in this cast for some time based on your orthopedic surgeon's preferences, although some surgeons now advocate early gentle motion.
Your orthopedic surgeon will see you after surgical repair or after a period of immobilization in a cast. Your thumb will be reexamined. The doctor will decide if you need to continue to immobilize your thumb or if you need physical therapy to regain movement in it. The remainder of your rehabilitation and the management of any chronic problems that may arise from your injury will be addressed by your orthopedic or hand surgeon.
Skiers should be taught to consciously discard the ski pole during all falls. Falling onto an outstretched hand while skiing without the ski pole in hand should minimize the chance of injury. Skiers should also be encouraged to use poles with finger-groove grips without any restraining devices such as a wrist strap or closed grip.
You can prevent skier's thumb during a car accident by keeping your thumbs on the outside of the steering wheel along with your fingers. This new routine will require a conscious effort because most drivers are taught to grip the steering wheel in a fashion similar to a ski pole.
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