Grumpy old…. thumb

Do you have a painful thumb - at the base near your wrist? 
Well, you are not alone. Many people have thumbs that demonstrate the “kisses of time”. And just like those people we label as “grumpy old men” our thumbs can be grumpy and painful too. A painful thumb can often mean there are some arthritic changes in the base joint of your thumb. You might even have been told you have arthritis there, or osteoarthritis (OA).

Thumb arthritis occurs more in women than men but what is common to anyone with thumb OA is the restriction in what they can do, mainly due to pain. Not being able to open a jar or bottle of water or hold a coffee can be very frustrating as well. Some people have even given up activities they love.

If you’ve already googled thumb arthritis, you may have seen some images of quite dramatic looking arthritic thumbs. This doesn’t happen for everyone. Sometimes you can experience pain without any changes showing up on X Ray. This is because pain is a protective or warning system to alert us to look after whatever hurts.

So here are some tips on looking after your thumbs:

1. Relieve the strain - respect pain: When your thumb starts to complain, back off the activity, take a rest or change what you are doing.

2. Change the load: In pinch, the pressure applied between your finger and thumb tip is multiplied tenfold at the base of your thumb. That’s why you need to avoid tight grip and pinch. You can change the load in other ways by changing how you do things or building up the handle / grip on tools you use. There are also other devices around that make it easier to do things when your thumb aches or feels weak.

3. Balance activity and rest: Keep moving but not too much. Listen to you body and give your joints the recovery time they need. That means relaxing and taking regular breaks. Planning what you do will smooth the process.

4. Be fitted with a thumb support that works for you. These can be very useful to get you back doing things you may have given up on, or keep you doing the things you love.

5. Find ways to settle down that grumpy thumb: Heat packs, massage and supports are good options.

And if you need more help, come on in to see us. There is more information and some nifty things we can show you to quieten down painful joints and set you up to look after your hands. Then you can get back involved in the things  you love to do. 

 

Skier’s thumb: What, more names!

It might be that your thumb has been quite badly injured or it’s been dislocated more than once. Injuries to the UCL are classified according to degree of injury and include:

• Complete tears of the ligament

• Large fractures associated with where the ligament attaches to the bone

• Stener’s lesion - more on that below

• Gamekeeper’s thumb - another fancy name! Read on.

How are these diagnosed? 
A good history of injury and an assessment of your thumb provides important information. There are some ligament stress tests we can do as part of our assessment. photo
As mentioned in the first blog Skier’s thumb in Darwin? link an X Ray will show up a fracture and how large that is. ? XR photo The other imaging options are ultrasound and MRI. These determine the extent of tearing to the ligament and the presence of a Stener’s lesion or complete tear of the ligament.

A Stener’s lesion is when the torn part of the UCL is blocked from it’s attachment by the adductor pollicus (AP) tendon (a strong thumb muscle) which inserts at the same spot. This prevents the ligament healing.

A Gamekeeper’s thumb is the name given to chronic UCL injuries. It might be a repeat injury or one that hasn’t been treated effectively initially. It means your joint isn’t stable and is usually painful and weak.

If you have a more complex injury, we always recommend you see a hand specialist.

What would a specialist do? 
The specialist makes the call on whether you need surgery and what procedure is best. The aim is to have a stable thumb so you can pinch & use your thumb normally without it giving way or being painful. 

What happens if I’ve had surgery?
Hand therapy plays an important role in your recovery.  We show you what to do after surgery, how to reduce swelling and look after the wound.  A removable  thermoplastic thumb splint  is made to accomodate the dressing and to protect the joint.. Photos  There may be more than one splint made for you in order to promote early movement and prevent stiffness. Once the wound is healed, you are shown some scar management techniques and exercises to keep the tendons around the joint gliding. The splint is worn for 6 weeks and then we’d gradually wean this off. 

Strengthening is a really important part of recovering control in your thumb after surgery. We target the stabilising muscles so you get back to what you love more quickly. If your thumb is stiff, we can work with you on that too.
 

Skier’s Thumb FAQs

Skiers thumb is an injury to the ulnar collateral ligament of the middle thumb joint (aka MCP joint). There are different degrees of injury. Today we are talking about the steps you would expect once your treatment has begun.

“When can I …?“ Then follows - play sport or get back to work or yoga or the gym? 
If the UCL tear is partial and things are improving (your thumb is more comfortable) then we can discuss how to get  you back to sport or work safely. When the tear is larger, then it’s important to allow enough time for ligament healing before it’s stressed too much. The decision is made based on how safe the activity is for your thumb. If it’s a team sport the first step is to get the OK from your coach. 

From our perspective we want to ensure your thumb is protected well. We hand therapists are a innovative lot so can make you a splint to wear for your particular sport or activity. Photo This is usually taped in place or worn under a glove. Then you get to try it out in a training session.

“I’ve been wearing a splint for 6 weeks - what next?”
Ligaments usually take about 6 weeks to heal enough to take more load and need less support. But this does vary. A bigger tear will need longer recovery time and can be quite irritable for a while. We usually start weaning you from the splint at 6 weeks and see how you thumb goes. There may be some activities you decide to wear your splint and then it’s taken off again. That’s OK and you get to make the decision with some guidance from us.

“My thumb’s still hurting - is that normal?”
In a word, yes, specially when there is a bigger injury. We can help you with techniques to settle that grumpy joint, using heat, massage, taping techniques, or making a neoprene support. We show you ways to unload your thumb too. Sometimes your thumb just needs some TLC. 

“How do I get my strength back?”
We will have already talked to you about exercises as these start even when you are in your splint. Once your thumb is feeling better, you can get into strengthening your thumb and hand. Photos We use stress balls, exercise putty, elastic bands and other tools to get your thumb back happily playing it’s part when you are using your hand. 

There are a couple of more severe injuries to the UCL for our next blog. So read on.