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Complete List of Dislocated Thumb Treatment Options

by Jaydee Vykoukal, PT, DPT October 31, 2021 0 Comments

wearing thumb brace

A dislocated thumb most often occurs when one of the local joints sustains a high impact and/or is hyperextended beyond its limits. The most common causes are from participating in sports like basketball and volleyball. Since we need our thumbs for everyday use and sport, a dislocated thumb can leave you feeling totally off your game (especially if it’s your dominant hand). Plus, since the thumb is a highly active area you may find yourself constantly re-injuring it. Knowing what to do to prevent aggravation and promote optimal healing can help you get back to normal life. Keep reading to learn about all the best options for treating a dislocated thumb (or any other type of dislocated finger).

Dislocated Thumb Treatment Options

When it comes to treating a dislocated thumb, it is important to first seek immediate medical advice. You don’t want to risk dealing with a chronic deformity of the thumb that can quickly affect your ability to function normally in your day to day activities and beyond. Once you have an appropriate diagnosis and your dislocation has been reduced and stabilized, you can explore the following treatment options. Initially, the focus will be on stability and symptom management. Then, from there you can progress to more functional rehab moves and beyond.

Bracing or Splinting

A dislocated joint indicates that local tissue stability has been compromised due to overstretching. To allow healing and regain stability of the affected thumb joint, immobilization with buddy taping (not as common with the thumb), a brace, or a splint will most likely need to be utilized to hold the thumb in a normal position and stabilize any potential broken bones. While local stabilization is definitely required, you might find your doctor recommends a brace that supports the wrist as well since many of the thumb tendons that may be affected cross the wrist joint too. Follow your doctor’s orders for wearing your brace or splint, keeping it on at all times, particularly at night, until you are instructed to start weaning from it. Depending on the severity, you can expect to wear one for approximately 4 to 6 weeks.

Cold Therapy

Use of ice can help with both pain and swelling management following your injury. Grab a small ice pack or ice cup to apply every couple of hours for the first few days of your injury and beyond (you can reduce the frequency once swelling has started to subside, typically in about three days). For an ice pack, use a thin t-shirt or dish towel (not a thick towel) between your skin and the ice and keep it in place for 10 to 20 minutes at a time. For an ice cup, apply the ice directly to the injured area and move it in small circular motions for 5 minutes or until the area is numb. The goal is to get pain relief and numbness, once you have achieved this with either method you can remove the ice to prevent frostbite.

For additional relief, you can also try a gentle hand massage or pain cream (before or after using the ice). Plus, you can try adding electrical stimulation to your hand or wrist while applying ice too.

Elevation

To boost your efforts with the use of cold, also elevate your hand while using ice. Keeping the hand elevated above the heart helps with swelling management to reduce pain and allow healing. Throughout your day, try to be aware of where your hand is, especially while you’re resting. Keep your hand propped in a way that keeps it above your chest level, especially when lying down.

In addition to elevation and ice, the use of compression with tape, bandages, or a compression glove can also promote pain relief and reduce swelling. Using them all in combination with adequate rest is the best way to keep your acute symptoms or any flare ups as you recover under control.

Anti-Inflammatory Medicine

With a severe injury or symptoms, especially if surgery is required, your doctor may prescribe you medication for pain management. If so, follow your doctor’s instructions for taking them. Otherwise, over-the-counter anti-inflammatory medication (NSAIDS), such as naproxen and ibuprofen, are your best bet for getting the pain relief you are looking for. If you’re not sure what is safe for you to be taking, always talk to your doctor first. Initially, it’s most likely best to take your NSAIDS on a schedule to keep symptoms well managed and then gradually wean from there. Then, you can take them as needed with any particularly aggravating activities.

It’s important to note that use of these medications should not be for long term use due to the risk of side effects when used chronically, such as organ damage.

Rehab Exercises

Once you have allowed adequate healing time and you have been cleared by your doctor, it’s time to start exercise. When you can start will ultimately depend on the severity of your injury. Working with a trusted medical professional will give you the best possible outcomes, such as an occupational therapy or physical therapist. There are even physical therapists that are specially certified in hand treatment that you can work with too. They will work with you to design a personalized program that gets you back to your normal daily routine as soon as possible.

What you can typically expect from an exercise progression for the thumb is the following:

  • Gentle passive thumb, hand, and wrist range of motion and stretching (with guidance from your PT or using your opposite hand)
  • Gentle active thumb, hand, and wrist range of motion and stretching
  • Targeted strengthening exercises for affected muscles (including muscles that have gotten weak due to wearing a brace)
  • Functional strengthening that focuses on thumb, hand, and arm coordination
  • Sport (or daily activity) specific exercise that prepares your thumb for a safe return with lower risk or re-injury

Below is a progression of exercises that you will most likely encounter when working with a hand therapist, including the tools you need to optimize each of them:

  • Flexion and extension range of motion of each of the thumb joints
  • Abduction and adduction range of motion of the the metacarpophalangeal joint (MCP- the middle thumb joint)
  • General hand and wrist stretches- including flexion, extension, radial deviation, ulnar deviation, pronation, and supination
  • Isometric thumb exercises- including pinching, gripping, flexion, extension, abduction, and adduction- utilizing therapy putty, a hand exercise ball, and/or hand extension exerciser to push against 
  • Active thumb range of motion with the goal of working through full range over time
  • Resisted thumb range of motion with the use of bands and/or therapy putty
  • Wrist strengthening exercises (and any other arm exercises that are relevant)- including wrist flexion, extension, radial deviation, and pronation/supination with a small dumbbell 
  • Activity specific exercises and biomechanical training for sports and beyond- such as dribbling a ball, throwing a ball, hitting a ball, writing, typing, cooking, etc.

For thumb specific exercises, reference this video:

For general finger exercises with hand putty that can be specifically tailored to the thumb, look here:

For wrist strengthening exercises, reference this video:

When to Consider Surgery

Any type of surgical intervention should be reserved only for severe thumb injuries, most often related to sports injuries. Your doctor will most likely need further imaging to decide what’s appropriate, such as an x-ray or MRI. For a dislocated thumb, issues with severe instability, a torn ligament (severe sprain) or tendon (strain), or a complicated fracture may warrant the need for surgery. In the case of a thumb, an orthopedic surgeon will most often perform what’s called an “open reduction.” Surgery will require more recovery time and increase the risk of complications like scar tissue adhesions and loss of thumb range of motion. Talk to your doctor about any concerns you have regarding surgery prior to and after the procedure is complete.

Rehabbing Your Dislocated Thumb

Nursing your thumb, or any other type of finger dislocation, back to good health all starts with a good plan for managing your symptoms and promoting proper healing. The recommendations listed above are all a great place to start when it comes to hand injuries. Once your symptoms are improving, starting appropriate rehab exercises will ensure you restore your thumb and hand function as soon as possible with fewer risks of complications. Remember to be patient and give your thumb the time it needs. If your symptoms aren’t starting to improve within a few weeks or they are getting worse, get in touch with your healthcare provider for further medical advice.

Resources:

https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uf7744

https://www.medicalnewstoday.com/articles/324683

https://www.fairview.org/Patient-Education/Articles/English/t/h/u/m/b/Thumb_Dislocation_116734en

PRODUCTS FOR THUMB PAIN

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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT



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