A dislocated thumb occurs when the bones forming one of the thumb joints move out of their normal alignment. The thumb has two joints, the interphalangeal (IP) joint closest to the nail and the metacarpophalangeal (MCP) joint at the base.
This injury is often caused by hyperextension or forceful trauma common in sports, resulting in a visibly deformed joint, sharp pain, and swelling.
Delaying treatment can increase swelling, potentially complicating the eventual realignment procedure. Prompt medical attention is necessary to ensure the joint is restored safely and to prevent long-term damage to the surrounding structures, such as ligaments, nerves, or blood vessels.
Immediate Steps Before Medical Help
The first and most important step after a thumb dislocation is to stabilize the injury and seek professional care without delay. You must immobilize the thumb exactly as it is, which prevents any further potential damage to the surrounding tendons and nerves. Never attempt to force the joint back into place yourself, as this untrained manipulation can cause severe complications, including tearing ligaments or damaging the joint cartilage.
To stabilize the thumb, you can use a makeshift splint crafted from household items like a pen or rolled newspaper. Secure the rigid material gently alongside the thumb with tape or gauze, ensuring that the taping does not cover the joint or restrict circulation. The goal of the splint is to keep the thumb from moving while you travel to a medical facility.
Applying ice can help manage both the pain and the swelling that immediately follow the injury. Wrap an ice pack in a thin cloth and apply it to the injured area for about 10 to 20 minutes at a time. Additionally, elevating the hand above the level of the heart can help reduce fluid buildup and inflammation. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can also be used to ease discomfort while waiting for professional treatment.
Professional Medical Procedures
Upon arrival at a medical facility, the initial assessment includes a physical examination to check for deformity, swelling, and any signs of nerve or blood vessel compromise. Imaging tests, specifically X-rays, are required to confirm the dislocation and check for associated injuries, such as fractures or bone fragments. These images help the medical team determine the approach for the realignment procedure.
The primary treatment is typically closed reduction, where the doctor externally manipulates the bones back into their correct anatomical position. Before this manipulation, the area will be anesthetized, often using a local anesthetic block to numb the thumb and minimize pain during the realignment. The technique involves a specific, controlled push or pull on the thumb, which varies depending on whether the joint is dislocated toward the palm (volar) or the back of the hand (dorsal).
Once the reduction is complete, another X-ray is taken to confirm that the bone alignment is successful and stable. If the closed reduction is unsuccessful, or if the initial X-rays show significant associated issues like large fractures or severe ligament tears, an open reduction may be necessary. Open reduction is a surgical procedure that allows the surgeon to directly access the joint, clear any soft tissue or bone fragments blocking the joint space, and repair damaged ligaments. After either procedure, the thumb is immobilized in a splint or a thumb spica cast for several weeks to allow the surrounding joint capsule and ligaments to heal.
Rehabilitation and Preventing Reinjury
Following successful reduction and immobilization, the healing phase focuses on restoring full function and stability to the thumb joint. The immobilization period in a splint or cast typically lasts between three to six weeks, though the exact duration depends on the severity of the initial injury and the specific joint involved. It is important that the thumb not be kept immobilized for too long, as this can lead to permanent stiffness and loss of joint mobility.
Once the period of initial immobilization is finished, physical therapy begins to address the stiffness and weakness that developed during the healing process. The initial exercises focus on gentle passive and active range-of-motion movements to slowly regain flexibility in the affected joints. These are gradually advanced to strengthening exercises, which may involve using therapy putty, small hand weights, or a stress ball to improve grip strength and thumb coordination.
The full recovery process can take several months. Ligament healing takes around six to eight weeks, and the return of full function potentially takes up to three to six months. To prevent reinjury, patients should follow a therapist’s recommendations for strengthening the muscles around the joint. Protective measures, such as wearing a protective splint or supportive taping during high-risk activities like contact sports, are recommended until the thumb’s stability is fully restored.