Sprained thumb questionnaire
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A sprained thumb is an injury of an overextended or torn ligament connecting the bones at the base of the thumb. Symptoms include swelling, bruising, and pain.
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.
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).
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.
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.
Over-the-counter pain medications are almost always sufficient to treat pain from even severe sprains. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used both at home and in the ED.
- To address pain during examination: In the ED, you may receive medication either by mouth or by IV to reduce the pain and facilitate the examination of the physician. In some cases, a physician may apply an anesthetic injection to the joint to allow for an easier exam of the thumb and to reduce discomfort.
- If pain does not decrease: Proper pain medication is necessary, but the need for pain medication for a mild sprain should decrease within the first 48 hours or even the first 24 hours. If the pain is consistent and does not improve, you may need medical attention for a moderate sprain, severe sprain, or a fracture.
- For further relief: Ice is one of the most useful and benign treatments for a thumb sprain and can be applied as frequently as tolerated. Usually, after transitioning from anti-inflammatory medications, ice can be used readily for two or three days after an injury. Be sure to use a cold pack and not apply ice directly to the skin.
Immobilizing a joint is necessary and can be done in many different ways.
- Immobilization types: If you visit the emergency department, the staff should refer you to resources indicating how to properly wrap a thumb joint in preparation for the healing process. They may place a cast, called a "thumb spica," upon the hand to immobilize the thumb or use a compression wrap. This depends on the degree of the sprain.
- To address stiffness: Additionally, while immobilization is necessary up to a month after the injury for proper healing, in the early stages of healing it may contribute to stiffness. To alleviate this, there are stretches that can be done routinely to avoid stiffness of the joint if you are not placed in a cast.
In cases of a full thickness tear of the thumb ligament, surgery to reconnect the ligament is necessary to re-establish proper function. These procedures are often favorable.
- Imaging: The joint will need to be examined on X-ray and possibly MRI prior to surgery.
- Immobilization for healing: After the surgery, the thumb will likely require immobilization for a few days to allow healing and prevent a secondary avulsion, tear or sprain.
- Follow-up: After this period, you will need to follow up with your surgical team either via phone or in person likely at two weeks and again at one month after the surgery depending on hospital policy.
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.
Questions your doctor may ask to determine sprained thumb
- Have you been experiencing dizziness?
- Do you hear a ringing or whistling sound no one else hears?
- Are you feeling irritable (easily made upset)?
- What sport were you playing when you were injured?
- Do you suffer from memory loss?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Ezekiel Richardson is a fourth-year medical student at UPenn, currently applying into Emergency Medicine. He completed an undergraduate degree with a concentration in health disparities at Stanford University. After graduation, he spent a year working in the Maryland Department of Health as a John Gardner Public Service Fellow. Between his third and fourth year of medical school, he completed multiple publications on public health and health accessibility through the Center for Emergency Care and Policy Research Fellowship. He has participated as a teaching assistant in anatomy, histology, and doctoring ethics courses at UPenn. Outside of medical school, he enjoys cooking, volunteering, and traveling in support of his partner’s work on girls’ education in Africa.
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- 5 exercises to improve hand mobility. Harvard Medical School: Harvard Health Publishing. Harvard Health Publishing Link
- Tomaino MM, Pellegrini VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. The Journal of Bone and Joint Surgery. 1995;77(3):346-355. NCBI Link