A sprained thumb occurs when the thumb ligaments are stretched beyond their capabilities, sometimes leading to a tear in the ligament. This is usually as a result of excessive force bending the thumb backwards. It is a common sports injury, but we most typically see thumb strains when someone falls onto an outstretched hand.
In an acute injury, the thumb is pushed drastically away from the rest of the hand (while skiing, fall or during contact sport.)
In a chronic thumb ligament injury scenario, a recurrent strain of this ligament leads to chronic rupture (gamekeeper’s thumb.)
Symptoms of thumb ligament injury will differ based on the grade of the thumb sprain, however, here are the general symptoms to look out for if you believe you may have sprained your thumb:
Ultrasound scans and MRI scans can directly visualise and confirm whether the thumb ligament has been injured.
During clinical examination, the laxity of the ligament on the injured thumb will be compared to the non-injured thumb. The level of the ligament laxity indicates the degree of ligament injury. Plain x-rays may show a small fracture, but are often normal.
The thumb ligament injuries (ulnar or radial collateral ligament), where the ends of the ligament are still in contact or close proximity, treatment in plaster for 6-8 weeks will be required.
Majority of complete ulnar collateral ligament injuries to the thumb are treated operatively. Once the ligament snaps one part of the torn ligament can flip onto the wrong side of a nearby tendon. This prevents the ligament ends from healing directly to each other.
The surgery is a day case procedure usually under general anaesthetic and takes about 30 minutes. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. The ligament is repaired to its bony origin using a bone anchor. The repair is then protected by putting the thumb in a plaster.
Thumb ligament injuries are categorised into three different grades based on the severity of the injury:
Grade 1 (mild sprain) – The ligaments have been stretched, causing discomfort and swelling, however there is no tearing.
Grade 2 (moderate sprain) – The ligaments have been extensively stretched, causing a partial tear. There may be some loss of function noticeable.
Grade 3 (severe sprain) – The ligament has been forced back severely, causing a complete tear. This is a significant injury and requires medical, potentially surgical treatment.
After treatment of your thumb ligament injury, the hand should be kept dry and clean until the wound has healed. One week after the procedure the plaster will be removed and a supportive splint will be applied by a hand therapist. Supervised motion will be started by the hand therapist at one week. Heavy activity or stress on the thumb joint is not allowed for 8 weeks.
Driving may not be possible for 6-8 weeks depending on which thumb is affected.
Your return to work will depend on your job. Light manual workers can return to duty in 4-6 weeks. Heavy manual workers should not exert maximal grip for 8-12 weeks.
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