Overview

During a fall, you usually extend your arm to reduce the force of the impact when you hit the ground. If you try to break your fall on the palm of your hand or take a spill on the slopes with your hand strapped to a ski pole, your thumb may be injured. The main ligament (ulnar collateral), which supports pinch and grasp activities, may be torn (sprained). The ligament helps your hand to function properly, acting like a hinge to keep your thumb joint (metacarpophalangeal) stable.

Diagnosis

When you have a sprained thumb, you lose some or all of your ability to grasp items between your thumb and index finger. It may or may not hurt right away. Other signs include bruising, tenderness, and swelling. To make sure your injury won’t cause long-term weakness, pain, and instability, see your doctor for evaluation and treatment.

Your thumb ligament may have a partial or complete tear. Your doctor will probably move your thumb joint to test its stability and take x-rays to make sure you don’t also have a broken bone. You may also get a stress x-ray showing what the joint looks like when your ligament is being used. If it hurts to do this, a shot of local anaesthetic may help. Your doctor will probably also x-ray your uninjured thumb for comparison.

Treatment Options

If you have a partial tear, your doctor will probably immobilize your thumb joint with a splint or other bandage until it heals. You wear the splint for about three weeks, then start taking it off to do flexion and extension exercises with your thumb. Put the splint back on for protection when you are not doing the exercises. Keep doing this for another two or three weeks until the swelling and tenderness are gone. You may also put ice on your thumb twice a day for two to three days after the injury.

If your thumb ligament is completely torn, you may need surgery. Fragments of bone that sometimes get pulled away when your ligament tears may be removed or put back in their correct positions. After surgery, you’ll probably need to wear a short-arm cast or a splint to protect your thumb ligament for six to eight weeks while it heals.

How can I prevent a thumb sprain?

Since thumb sprains are nearly always results of falls or other accidents, there is not much that can be done to prevent them.

However, thumb sprains caused by overuse can be avoided by applying ice to the thumbs after each training session and using rehabilitation exercises to increase strength of the hand muscles and maintain flexibility of the thumb joints.

The best way to prevent reoccurrences of a thumb sprain is to only return to practice and competition when all symptoms of the injury are gone and strength of the affected thumb has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured joint.

Improving sports performance

The key to improving sports performance after recovering from a thumb sprain is a proper a rehabilitation program and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is by utilizing the stretching exercises mentioned above before and after you step onto the field, court, ice, or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Thumb sprain rehabilitation

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

The most common rehabilitation for a sprained thumb often includes the following:

• Rest
  Do not perform activities that cause pain during the acute phase.
• Ice
  Apply ice or a cold pack to the thumb for 15 to 20 minutes, 4 times a day for few days.
• Medication
  Take ibuprofen to help reduce inflammation and pain.
• Compression
  Wrap your thumb in an elastic compression bandage (Ace bandage) to l limit swelling and support your thumb joint.
• Stretching
  When the acute pain is gone, start gentle stretching of the thumb as recommended by your doctor. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.

Rehabilitation exercises

The primary focus of rehabilitation for a thumb sprain is to prevent aggravation of the existing injury. This means refraining from the activity that caused the injury and from similarly hazardous activities, as well as using appropriate support in the form of a splint or cast when being physically active.

Regaining and increasing the original range of motion of the injured thumb joint facilitates recovery and reduces the possibility of reinjury. Exercises to increase the range of motion of the base of the thumb follow. Many sports and activities expose the thumbs to injury. Once injured, reinjury is more likely. These exercises are thus recommended for both hands as a preventive measure.

• Thumb extension
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Grasp the injured thumb with the forefinger of the opposite hand. Gently draw back on the injured thumb, stopping at the point of pain. Hold the injured thumb in this position for 10 seconds, then release and rest for 10 seconds. Do this sequence five times, three times per day. You should be able to draw the injured thumb back a bit further with each day. If not, see your doctor for advice.
• Thumb flexion
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Move the injured thumb inward so that the end of the thumb is brought as closely as first pain permits to the base of the small finger of the same hand. Hold this position for 10 seconds, then relax the injured thumb for five seconds. Perform this sequence 10 times, three times a day. From day to day it should be possible to press the injured thumb closer to the base of the same-side small finger. If not, see your doctor for advice.
• Hand grasp
  While seated, place the elbow of the injured-side arm on the same-side thigh with elbow at a right angle. Using a grasping ball (available at most pharmacies), grasp the ball in the palm of the hand with the thumb and fingers and squeeze as firmly as pain allows. Hold this position for 10 seconds, then relax the injured hand for five seconds. Perform this sequence 10 times at least three times daily. From day to day greater grasping force without significant pain should be possible. If not, see your doctor for advice.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• swimming
• jogging
• stationary bicycle

How long will the effects of my injury last?

A thumb sprain from overuse usually lasts 2 to 4 weeks, provided that you refrain from the activity that caused the injury and followed the rehabilitation program. These symptoms gradually lessen over time, so they may prohibit normal training for only 7 to 10 days.

When the thumb has been sprained in an accident, the duration of effects vary with the degree of the sprain. With first- and second-degree sprains, symptoms may persist on some level for 3 to 6 weeks. Third-degree sprains of the thumb may require surgical treatment, and full recovery can take months.

When can I return to my sport or activity?

It's not advisable to return to your sport until all signs of swelling and pain have subsided. This includes painless full range-of-motion. If the injury is from overuse, you may return to activity if you simply modify the way you use your thumb. This can be achieved by positioning it differently than you did before.

If the thumb has suffered a first- or second-degree sprain, you may return to activity within two weeks if you wear a protective splint or cast. Full return without such protection generally takes four to six weeks. When there has been a third-degree sprain, full return to training and competition may take several weeks and may require a protective cast.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your thumb sprain recovers, not by how many days or weeks it has been since your injury occurred.

A good rule is to allow pain to dictate when you're ready to return to activity. You should return in moderation, and back off if you feel any pain.