Thumb Sprain

Thumb Sprains
Thumb Sprains: Causes, Types, and Treatment

A thumb sprain is an injury to the ligament that connects the bones to the joint, often caused by a fall or a sports-related injury. In a sprain, the thumb is typically bent beyond its normal range of motion, which can result in swelling, pain, and bruising at the affected area.

Common Thumb Sprains

Two ligaments are commonly injured during a thumb sprain:

  • Ulnar Collateral Ligament (UCL): Located on the medial side of the thumb, the ulnar collateral ligament is the most commonly injured in thumb sprains. It is often associated with a condition known as “skier’s thumb”, as it is frequently seen in skiing accidents.
  • Radial Collateral Ligament (RCL): This ligament is located on the lateral side of the thumb and is less commonly injured compared to the UCL.
Treatment for Thumb Sprains

If you suspect a thumb sprain, it is essential to see one of the trained physicians at South Florida Hand and Orthopaedic Center. The doctor will perform an x-ray to rule out any bone fractures in the hand or thumb. Following the imaging, a physical examination will help assess the severity of the sprain.

Both ulnar and radial collateral ligament sprains are typically treated with a cast or splint to immobilize the thumb and promote healing. If the injury is severe or does not respond to conservative treatment, further intervention may be necessary.

De Quervain’s Tendonitis or Wrist Tendonitis

de Quervain’s Tendonitis or Wrist Tendonitis
De Quervain’s Tendonitis: Causes, Symptoms, and Treatment

De Quervain’s tendonitis (first dorsal compartment tendonitis) occurs when the tendons at the base of the thumb become irritated or inflamed. This inflammation causes the compartment (a tunnel or sheath) around the tendon to swell and enlarge, leading to pain with thumb and wrist movement. Activities such as making a fist, grasping, or holding objects often trigger pain in this condition.

What Causes De Quervain’s Tendonitis?

This condition is often caused by repetitive activities that place strain on the tendons. Specific factors that may contribute include:

  • Repetitive activity: Taking up a new repetitive activity can stress the tendons, leading to inflammation.
  • New mothers: The act of caring for an infant often leads to awkward hand positioning, making new mothers especially prone to this tendonitis. Hormonal changes during pregnancy and nursing may also contribute.
  • Wrist fractures: A history of wrist fractures may predispose individuals to de Quervain’s tendonitis due to increased stress across the tendons.
Signs and Symptoms of De Quervain’s Tendonitis

The primary symptom of De Quervain’s tendonitis is pain on the thumb-side of the wrist. This pain can appear suddenly or gradually and is located at the first dorsal compartment at the wrist. Other signs and symptoms include:

  • Pain radiating: The pain may radiate down the thumb or up the forearm.
  • Worsening pain with movement: Thumb and hand motion, especially forceful grasping or twisting, increases the pain.
  • Swelling: There may be noticeable swelling at the base of the thumb, sometimes with a fluid-filled cyst.
  • Catching or snapping: Occasionally, you may feel a “catching” or “snapping” sensation when moving the thumb.
  • Numbness: Irritation of the nerve over the tendon sheath can cause numbness on the back of the thumb and index finger.
Diagnosis of De Quervain’s Tendonitis

Your doctor will likely ask you to make a fist with your fingers clasped over your thumb, and then bend your wrist in the direction of your little finger. This maneuver will be very painful if you have de Quervain’s tendonitis, helping your doctor confirm the diagnosis.

Wrist Tendonitis Treatment

The goal of treatment is to relieve the irritation and swelling causing the pain. Treatment options may include:

  • Rest: Wearing a splint to rest the thumb and wrist and prevent further strain.
  • Anti-inflammatory medication: Oral anti-inflammatory medications to help reduce pain and swelling.
  • Cortisone injections: Steroid injections into the tendon compartment to reduce inflammation.

These non-operative treatments often provide relief by reducing swelling. In some cases, simply stopping the activities causing the irritation can allow symptoms to resolve on their own.

Surgical Treatment for Severe De Quervain’s Tendonitis

If symptoms are severe or do not improve with conservative treatment, surgery may be recommended. The procedure involves opening the compartment to create more room for the inflamed tendons, thus relieving the pressure and breaking the cycle of irritation. Following surgery, you can resume normal hand use once comfort and strength have returned.

If you are experiencing symptoms of De Quervain’s tendonitis, consult with South Florida Hand and Orthopaedic Center to discuss your treatment options and find relief from pain.

Arthritis of the Thumb

Arthritis at the Base of the Thumb
Basal Thumb Arthritis: Causes, Symptoms, and Treatment

In a normal joint, cartilage covers the ends of bones, acting as a shock absorber to allow smooth and pain-free movement. However, in osteoarthritis (OA), the cartilage layer wears away, leading to direct bone contact. This results in pain, deformity, and limited range of motion. The base of the thumb is often affected by OA, particularly the carpometacarpal (CMC) joint, which is formed by the trapezium bone in the wrist and the metacarpal bone in the thumb. The specialized saddle-shaped structure of the CMC joint allows a wide range of motion, but OA can restrict this motion and cause significant pain.

Who Gets Basal Thumb Arthritis?

Basal thumb arthritis is more commonly seen in women over the age of 40. While the exact cause is unknown, several factors may increase the risk, including:

  • Genetics: A family history may increase the likelihood of developing OA.
  • Previous injuries: Past fractures or dislocations can predispose individuals to arthritis in the CMC joint.
  • Joint laxity: Generalized looseness of the joints can make the thumb more susceptible to arthritis.
What Are the Signs and Symptoms?

The most common symptom of basal thumb arthritis is pain at the base of the thumb, which can be aggravated by activities that require pinching, such as:

  • Opening jars
  • Turning door knobs or keys
  • Writing or gripping objects

As the condition progresses, pain may occur at rest or at night. In severe cases, the joint may deteriorate, causing misalignment and a bump at the base of the thumb. This misalignment can limit motion, cause weakness, and make pinching difficult. The joint above the CMC may compensate by hyperextending (bending backward).

How is the Diagnosis Made?

Your doctor will diagnose basal thumb arthritis based on a physical evaluation and your medical history. Common signs include pain with pressure, twisting, or movement of the joint, often accompanied by a grinding sensation. While X-rays are used to confirm the diagnosis, the severity of symptoms does not always correlate with the X-ray findings.

What Are the Treatment Options?

In less severe cases, thumb arthritis can often be managed with non-surgical treatments, including:

  • Arthritis medication: To help manage pain and inflammation.
  • Splinting: Rigid or non-rigid splints can be worn while sleeping or during activities to support the joint.
  • Cortisone injections: To provide temporary relief from pain and inflammation.

If non-surgical treatments fail or if the arthritis is advanced, surgical reconstruction may be necessary. Surgical options include:

  • Removal of arthritic bone and joint reconstruction: To restore joint function and reduce pain.
  • Joint fusion: Fusing the bones of the joint to eliminate pain, though it can limit motion.
  • Bone realignment: To correct deformities and improve function.

If you’re experiencing thumb joint pain, make an appointment with South Florida Hand and Orthopaedic Center to explore your treatment options and find relief.

Extensor Tendon Injuries

South Florida Hand and Orthopaedic 07
Understanding Extensor Tendon Injuries: Causes, Types, and Treatment

Located on the back of the hand and fingers, the extensor tendons are responsible for allowing you to straighten your fingers and thumb. These tendons are attached to muscles in your forearm and become flat and thin as they extend into the fingers. Smaller tendons from the hand muscles contribute to delicate finger motions and coordination.

Common Types of Extensor Tendon Injuries

Extensor tendons are located just beneath the skin, directly on the bone, making them highly vulnerable to injury, even from minor cuts. A jamming injury can tear these tendons away from the bone, resulting in difficulty straightening one or more joints. Common types of extensor tendon injuries include:

  • Mallet Finger: This occurs when the tendon at the end joint is cut or separated from the bone, causing the fingertip to droop.
  • Boutonniere Deformity: This condition results in a bent-down (flexed) middle joint of the finger due to a tear or cut of the extensor tendon.
  • Lacerations: Cuts on the back of the hand can damage the extensor tendons.
Treatment for Extensor Tendon Injuries

The treatment for extensor tendon injuries depends on the type and severity of the injury. Here’s what you can expect:

  • Cuts or Lacerations: A tendon cut may require stitches to repair the injury.
  • Jamming Injuries: Tears caused by jamming injuries are typically treated with splints that prevent the healing tendon from pulling apart.
  • Splinting: The doctor will apply the splint to the correct area and provide instructions on how long it should be worn. In some cases, a pin may be inserted through the bone to serve as an internal splint.

It is essential to follow the doctor’s instructions and wear the splint as prescribed to ensure proper healing and restore the functionality of the tendon. In severe cases, further intervention may be necessary to ensure full recovery.