Dislocated Thumb: Symptoms, Professional Treatment, and Recovery

How to fix a dislocated thumb?

Attempting to fix a dislocated thumb yourself is strongly discouraged due to the high risk of further injury and complications. Immediate medical attention is crucial for proper diagnosis and safe reduction.

Understanding Thumb Dislocation

A dislocated thumb occurs when the bones forming a joint in the thumb are forced out of their normal alignment. The thumb has two main joints: the carpometacarpal (CMC) joint at the base, and the metacarpophalangeal (MCP) joint at the knuckle, which is the most common site for dislocation. A less common site is the interphalangeal (IP) joint, which is the joint closest to the thumbnail.

Common Causes:

• Direct trauma: A forceful impact directly to the thumb.
• Falls: Landing awkwardly on an outstretched hand, putting direct pressure on the thumb.
• Sports injuries: Common in contact sports or activities where the thumb can be hyperextended or twisted (e.g., basketball, volleyball, skiing, wrestling).
• Hyperextension: When the thumb is bent backward beyond its normal range of motion.

Signs and Symptoms:

• Severe pain: Often intense and immediate.
• Obvious deformity: The thumb may appear crooked, bent at an unnatural angle, or shorter than the other thumb.
• Swelling: Rapid onset of swelling around the affected joint.
• Bruising: May develop hours or days after the injury.
• Limited or no movement: Inability to move the thumb or significant pain with any attempt.
• Numbness or tingling: If nerves are affected.

Why Self-Reduction is NOT Recommended

While the immediate instinct might be to "pop it back in," this is incredibly dangerous and can lead to severe, long-term complications.

Risks of Self-Reduction:

• Further injury: You could inadvertently cause a fracture (a broken bone), tear ligaments or tendons, or damage blood vessels and nerves.
• Incomplete reduction: The joint might appear to be back in place, but it could be partially dislocated or have soft tissue trapped within the joint, leading to chronic instability or pain.
• Missing other injuries: A dislocation can occur simultaneously with other injuries, such as fractures or severe ligament tears, which require specific medical management. Without proper imaging, these can be missed.
• Increased pain and swelling: Improper manipulation will likely exacerbate the injury.

Immediate First Aid Steps

If you suspect a thumb dislocation, follow these steps while awaiting medical attention:

1. Do NOT attempt to pop it back in: This is the most critical rule. Resist the urge to manipulate the thumb.
2. Immobilize the thumb: Try to keep the thumb as still as possible. You can gently tape it to an adjacent finger (buddy taping, but loosely) or use a makeshift splint if available, ensuring it's not too tight.
3. Apply ice: Place an ice pack (wrapped in a cloth) on the injured area for 15-20 minutes at a time, every 2-3 hours. This helps reduce swelling and pain.
4. Elevate the hand: Keep your hand elevated above the level of your heart to help minimize swelling.
5. Seek immediate medical attention: Go to an urgent care clinic or emergency room as soon as possible.

Professional Medical Treatment

A medical professional, such as an emergency room physician, orthopedist, or hand specialist, is trained to properly diagnose and treat a dislocated thumb.

• Diagnosis:
  • The doctor will perform a physical examination of your hand and thumb.
  • X-rays are essential to confirm the dislocation, rule out any associated fractures, and assess the exact direction of the dislocation.
• Reduction (Relocation):
  • This procedure, known as closed reduction, involves manipulating the bones back into their correct position without surgery.
  • It is typically performed under local or regional anesthesia to minimize pain and relax the muscles, making the reduction easier and safer.
  • The doctor will use specific techniques, often involving traction and precise movements, to realign the joint.
  • Post-reduction X-rays are usually taken to confirm that the joint is correctly aligned and no new fractures occurred.
• Immobilization:
  • After reduction, the thumb will be immobilized with a splint or cast (e.g., a thumb spica splint or cast) for a period, typically 2-6 weeks, to allow the ligaments and joint capsule to heal. The duration depends on the severity of the injury and the specific joint involved.
• Pain Management:
  • Over-the-counter pain relievers (e.g., ibuprofen, acetaminophen) or prescription pain medication may be recommended to manage discomfort.
• Surgery:
  • Surgery may be necessary in certain cases, such as:
    • Irreducible dislocations: When the dislocation cannot be corrected with closed reduction due to soft tissue entrapment (e.g., a "buttonhole" injury where a tendon or ligament gets caught).
    • Associated fractures: If there's a significant fracture along with the dislocation.
    • Severe ligamentous instability: If ligaments are severely torn and cause persistent instability after reduction.
    • Chronic dislocations: If the thumb repeatedly dislocates.

Recovery and Rehabilitation

Recovery from a dislocated thumb involves a period of immobilization followed by rehabilitation to restore full function.

• Following Medical Advice: It's crucial to adhere strictly to your doctor's instructions regarding immobilization time and activity restrictions.
• Physical Therapy:
  • Once the immobilization period is over and your doctor clears you, physical therapy is often recommended.
  • A hand therapist or physical therapist will guide you through exercises to:
    • Restore range of motion: Gentle exercises to regain flexibility in the thumb joint.
    • Strengthen the surrounding muscles: Exercises to improve grip strength and thumb stability.
    • Improve dexterity and function: Activities to help you return to daily tasks and sports.
• Gradual Return to Activity: Avoid activities that put stress on the thumb until fully healed and cleared by your healthcare provider. This may involve modifying sports techniques or using protective taping.
• Timeline: Full recovery can take anywhere from several weeks to a few months, depending on the severity of the dislocation, any associated injuries, and adherence to rehabilitation.

When to See a Doctor

Always seek immediate medical attention for:

• Any suspected thumb dislocation.
• Persistent pain, swelling, or deformity after an injury.
• Inability to move your thumb or hand normally.
• Numbness, tingling, or coldness in the thumb or fingers.

Conclusion

A dislocated thumb is a serious injury that requires prompt and professional medical attention. While the desire to "fix it" yourself may be strong, the risks of causing further, irreversible damage are too high. Trusting a healthcare professional for diagnosis, safe reduction, and guiding your rehabilitation is the best approach to ensure optimal recovery and prevent long-term complications, allowing you to return to your activities safely and effectively.