Sprained Thumb

What is a sprained thumb?

A thumb sprain occurs when the ligaments that connect the bones are strained by a sudden, forceful movement, usually when the thumb is stretched backward away from the palm. This is likely to occur when the thumb is directly impacted, such as partially catching a ball or falling on an outstretched hand.

Symptoms include swelling and pain in the thumb and surrounding areas, a loss of movement or a difficulty with your grip, a feeling of laxity or joint instability, as well as possible bruising.

Treatment can begin at home with rest, ice, and over-the-counter pain medication. Proper immobilization of the thumb with a cast may need to be completed by a medical team as well as possible surgery to repair any significant damage.

You should visit your primary care physician for an X-Ray. Although often a sprained thumb may be ignored with the hope that it will heal itself, if a ligament injury is not diagnosed and treated correctly, chronic instability may result.

Symptoms of a sprained thumb

Pain at the time of injury is common in cases of thumb sprain, but pain at the time of injury can occur with any injury to joints, muscle, ligaments or tendons (e.g. bruises, fractures, abrasions). It indicates damage to tissue but does not indicate which tissue may be damaged. Main symptoms, as well as other symptom specifics, are detailed below.

Main symptoms

The main symptoms of a sprained thumb include the following.

• Swelling: This usually lasts for up to a week after injury and depends on the degree of damage to the tissue. Determining if the pain is caused by a sprain requires a physical examination of the thumb and may require imaging.
• Bruising: Bruising is common during sprain from acute stress. Whatever force applied to the thumb joint that caused the ligament to stretch, tear, or avulse a bone is also sufficient to fracture blood vessels within the hand and cause a bruise. Bruises are self-healing unless you have an underlying condition causing you to bleed without natural coagulation (e.g. hemophilia, anticoagulant medications).

Immobility

Damage to the thumb may cause limited movement of the joint. This can be secondary to pain, following swelling or bruising, which may occur concurrently with a sprain or due to loss of stability in the joint.

• Range of motion in relation to pain: Your physician will determine if the loss of movement is caused by pain or by a lack of functional ability to move the thumb by ranging the thumb her or himself. To range a joint means to move it into certain positions to test the ability of the ligaments to stabilize a joint. This is often uncomfortable on a sprained thumb but is necessary to determine if a thumb is sprained, the severity of the sprain, and to rule out a fracture.
• Difficulty with grasping: This loss of movement can also make you unable to grasp or hold items between your thumb and forefinger, even when the pain has been minimized through medication.

Laxity or instability of joint

A loose or unstable joint can be caused by the absence of connections of the bones of the thumb by the possibly sprained ligament. This is, of course, if the ligament has been torn significantly or completely away from its points of attachment.

• Amount of stability lost can signify the severity of the tear: Usually, a complete tear will produce a significant loss in laxity or stability of the joint and can be diagnosed by physical exam, or in some cases, by a functional X-ray (e.g. a procedure in which the thumb is manipulated as X-ray images are taken of it).
• Pain will be addressed: Because of the pain involved in an examination like this, you may require an injection of a mild anesthetic to the joint.
• Joint dislocation: On X-ray, the joint will be slightly displaced or nearly dislocated because of the loss of the ligament (e.g. tether) between the bones of the thumb.

What causes a sprained thumb?

A sprain occurs when the ligaments that connect the bones are strained by a sudden and forceful movement. In the case of a thumb sprain, stretching the thumb backward away from the palm is the most common movement that can result in injury if it is fast or forceful enough. Common situations where this may occur include:

• Partially catching a ball and having it only contact the thumb
• Falling on an outstretched hand
• Falling while skiing with your hand strapped into a skiing pole
• Punching without a closed fist

Chronic repetitive stress on thumb

Gamekeeper's thumb affects the same ligament as skier's thumb. It occurs, however, when you damage the ligament through repeated stress on the ulnar collateral ligament of the thumb. The direction of force should press the thumb away from the palm. Thumb sprains from chronic injury can occur in a similar fashion today for individuals who need to quickly crush or apply force to an object. People who spend time kneading dough, molding clay, or breaking objects using their palm as a lever may experience a chronic repetitive stress injury leading to a thumb sprain.

Acute overextension of thumb

There is no single cause of a thumb sprain. Any force or action producing the correct pressure can cause a sprain. As stated above, the most common cause of sprain is an overextension of the thumb stretching or tearing the ulnar collateral ligament. Sprain is an inclusive term covering different degrees of damage to the ligament in question. A sprain may involve:

• First-degree sprain: This involves stretching a ligament too far.
• Second-degree sprain: This involves a partial tear of a ligament.
• Third-degree sprain: This is a complete tear of a ligament or separation of the ligament from the bone. In the case of a third-degree sprain, part of the bone may fracture and be pulled with the ligament (avulsion fracture).

Treatment options and prevention for sprained thumb

Treatments for mild sprains can begin at home. However, if your pain worsens or persists or you believe you have a more serious injury, seek medical attention promptly.

At-home treatments

Home care is appropriate for a mild sprain. Home care most frequently requires treatment of pain and immobilization to allow for proper healing. The mnemonic RICE is commonly used to remember how to treat mild sprains and other injuries of most common joints, including knees and ankles.

• Rest: This applies to hand use. You should avoid using your hand for 48 hours after the injury has occurred.
• Ice: You should apply ice to control the swelling which can further damage tissues and cause pain. It is especially important immediately after the injury but can also be used several times a day.
• Compression: Compression involves applying a tight but not restrictive wrap to the hand to reduce swelling and should be done over the course of the next week.
• Elevation: Raising your hand above your heart decreases swelling by making it more difficult for blood to flow into the hand. This can frequently be achieved by placing a hand on stacked pillows.

When to seek further consultation for sprained thumb

If you suspect you have a fracture or have evidence of a severe sprain, you should seek immediate medical attention. This would include a complete inability to range the thumb irrespective of pain.

If the thumb is visibly deformed

If your thumb is dislocated, distended, or broken, you should seek immediate medical attention.

If you have persistent pain after two weeks

Usually, the pain associated with a sprain dissipates within two weeks of a simple sprain. If the pain persists generally, on motion, or is not improving within one week of the injury, you should seek further medical attention.