Skier’s Thumb in Darwin?!

What’s in a name?
The name “skier’s thumb” comes from a skiing injury where the thumb is caught on a pole during a fall. This tears a ligament on the inside of your thumb.

There are lots of other ways this ligament can be injured - falling onto your hand, in a footy game when a ball hits your thumb, even during a tussle with kids or friends - basically any situation where your thumb is forced out and back. So yes, it happens in Darwin!

The ligament affected is the ulnar collateral ligament (UCL) of the middle thumb joint and attaches the metacarpal bone to the proximal phalanx bone. It provides fantastic stability to the side of the joint.

There are different types of injury to this ligament:
A partial or incomplete tear which affects joint stability a little but not drastically
A complete or full tear of the UCL, which de stabilises the joint.
An avulsion fracture when a piece of bone is pulled away from the proximal phalanx at the end of the ligament. These are evident on an X Ray.

What do you do if this happens?
The first thing is to use your RICE principles because your thumb swells and often becomes bruised. It’s usually painful too. Wrap your thumb up, reduce movement and load, ice in the first 24-48hrs and keep you hand up as much as you can. Then head into a hand therapist.

And what do we do? 
First of all we help you with early treatment including making a removable  thermoplastic thumb splint  to protect the ligament. This is waterproof and will allow you to use your hand while keeping your thumb safe. Photo
We always give you tips on looking after your thumb and what exercises are OK for you to do.  And we would usually send you for an X Ray to check if there is a fracture. Most often with this injury you wear the splint for 6 weeks.

Sometimes these injuries can be quite severe, in which case it’s wise to see a specialist. We can talk this through and point you in the right direction if necessary.

The next blog will tell you about how we help you down the track a bit from the injury. Stay tuned!

New mum’s painful thumb

New mums are busy - life is full on and focussed - and all about a little person who absorbs all your time (and energy). Sometimes a big change in how you are using your hands causes a problem with tendons of your thumb - a condition called “deQuervain’s”.  deQuervains occurs when two tendons to your thumb become aggravated as they cross your wrist producing pain and tenderness. It hurts to make a fist, pick up objects, holding your baby, breastfeeding, changing nappies, even putting on a seat belt. This obviously is a problem.

The tendons involved in deQuervains move your thumb out from your hand but also work on your wrist so that you can do a side to side movement. The combination of repetitive movements of both thumb and wrist, increased fluid or swelling and hormonal changes can contribute to developing this problem. 

What actually happens?
These thumb tendons become aggravated where they run through a compartment or tunnel the side of your wrist (photo). The lining of the compartment (called synovium) swells and reduces the space the tendons have, which makes the normal gliding movement difficult. The tendons themselves then become thickened which increases the friction and compounds the problem. 

Symptoms include:
Pain and tenderness on the thumb side of your wrist
Swelling or thickening in this area. 
Sometimes pain radiates up your forearm
Difficulty with pinch and gripping activities.

There are a couple of tests we use to diagnose deQuervains. One is Finkelstien’s test where the tendons are put on stretch, which results in pain. Ultrasound imaging can be helpful to determine thickening of the two tendons involved and the little tunnel they run through at the level of your wrist.

Can this be treated? 
Treatment starts with splinting, compression to reduce swelling, teaching  you how to look after your thumb and reduce the aggravation. Heat packs & massage can also really help to reduce pain.  You can expect to use a splint for any painful activities for about 4-6 weeks, although if your pain reduces quickly, we would free your hand up more quickly. Taping or a neoprene support can be useful in this process. 

If hand therapy alone doesn’t work well for you, a cortisone injection may be suggested by your GP. Otherwise a referral to a specialist for surgical opinion is considered if other treatment isn’t successful. 

The good news is that the earlier you seek expert treatment the more quickly you recover. And best of all, almost all new mums with deQuervains recover completely. 


Getting back into sport after a finger dislocation

“How long will I be out of the game?” is one of the first things asked after an injury. Everyone is dying to get off the sidelines or back to the gym. One very important aspect of what we do when treating sports injuries is to get you back to sport safely as well as quickly.  This involves discussion about the sport or activity you want to do, the type of stress your finger would be subject to and how severe your injury has been.  If you are involved in a team sport an OK from your coach (and doctor) is a good idea too.

Both innovation and skill come into the next step - a sport splint. We work with you on design and then make a splint that’s perfect for your sport. This will ensure your finger is protected well when you hold the bat, mark a ball or head to the gym.

A splint is used in sport for at least the first 6 weeks after injury. At that point, if the joint is stable, your movement has improved and your finger is less painful, the splint can be replaced with taping or buddy strapping. Once your finger is strong, mobile and pain free, no more taping is required. 

What to do with a grumpy joint?
Strength and movement are vital for your finger and hand to work properly. Sometimes dislocated fingers can be irritable, stiff and “grumpy”, which impacts how you use your hand. There are some tricks we can use to settle down a sore grumpy joint and gain movement. Thankfully for most people these joints settle quite quickly once you have the right techniques to soothe them. 

What about stiffness?
Frequently people have trouble with regaining finger extension (straightening your finger). If your joint is stubborn, it will take hard work to get your finger moving. Your hand therapist will give you exercises to strengthen the muscles, finger stretches and a night time splint to provide a gentle stretch and maintain your gains in movement. During the day, the priority is getting the bending in your fingers often by using your hand. 

Building up strength is the easy part after a dislocated finger. Putty, resistance balls, and other exercise tools are used extensively following these injuries.

But the very best thing you can do is get back to using your hand for all your normal activities including sport!