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Comments Off on Skier’s Thumb, more common than you think!

Skier’s Thumb, more common than you think!

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Blog Post by Erika Lassig

The most common thumb joint injury is called Skier’s Thumb or Gamekeeper’s Thumb. It occurs when the thumb is stretched too far away from the hand accidentally during a fall or playing sport. One of the supporting thumb ligaments is sprained or pulled off the bone with or without a small piece of bone attached. The thumb is usually swollen and painful to move, particularly when stretching it out or pinching and gripping. Often there is no sign of injury on x-ray, however there will be pain and sometimes instability of the joint indicating a ligament injury.

The ligament in question is called the Ulna Collateral Ligament (UCL) of the thumb metacarpophalangeal (MCP) joint. The good news is that most thumb UCL injuries recover well with therapy! There is only a small number that require surgery and in these cases it is because the ligament gets caught in some other soft tissue structures and cannot mend to the bone. This is called a Steiner Lesion and can be diagnosed on MRI if instability in the joint continues after casting or splinting treatment.

If you have a suspected Skier’s thumb injury, you will need to protect the injured ligament for 4-6 weeks in a splint or cast. A plaster cast is a cheap and effective way to rest injured joints, however if both the wrist and thumb are immobilised, then stiffness nearly always results. A hand therapist can provide you with a custom-made splint or orthosis, that only limits a small amount of thumb movement to protect the ligament but allows you to continue using your hand for many things. The splint is also removeable, allowing you to wash your hand and do some gentle movement exercises aimed at preventing stiffness.

Ligaments have poor blood supply and as a result take along time to heal. A hand therapist will be gradually increasing exercises, introducing strengthening at the appropriate time and giving advice regarding return to more demanding activities such as sports.

If you think you have a Skier’s Thumb injury, book an appointment with us today so that you can get back to what you love.

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Comments Off on Are you putting up with thumb pain?

Are you putting up with thumb pain?

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Blog post by Erika Lassig

If you have pain in your wrist or thumb when you write, use scissors, hold a knife or pinch things and you’re over 50, you may have base of thumb arthritis. This painful condition can prevent you from doing basic everyday things as well as leisure activities such as gardening or knitting. The good news is that you don’t need to give up four favourite hobbies!

The problem occurs from wear and tear of the mobile joint at the base of the thumb where it joins the wrist. We call this the first carpometacarpal (CMC) joint. The CMC joint is a saddle joint where the long bone of the thumb (first metacarpal) forms the rider and the small wrist bone (trapezium) is the saddle. The joint is highly mobile, allowing for the ability to oppose and rotate the thumb to form a wide variety of grip patterns from open grasp to pen grip to key pinch.

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Unfortunately, forces at the tip of the thumb are magnified twelve times at the base, meaning that 1kg or pinch force translates into 12kg of force through the first CMC joint. For many people over time the smooth protective cartilage that covers the joint surfaces wears away. What’s left is bone rubbing on bone which is painful and causes swelling of the joint which in turn stretches the supporting soft tissues. Over time the joint may slip out of alignment causes a “z” deformity of the thumb.

There is a surgical joint replacement procedure that can be done in very painful cases, but the surgery is painful and has a 6-month recovery time. Despite the wear and tear nature of first CMC arthritis, therapy can be very helpful in reducing pain and preventing progression of the disease.

Hand therapy for base of thumb arthritis takes a three-pronged approach. Firstly, a small thumb splint helps to rest the CMC joint, minimise forces through the joint and reduce pain during functional tasks. Secondly, exercises aim to strengthen the supporting muscles around the joint to prevent it slipping out of alignment. Lastly, your therapist will discuss activity modification and show you how to do the things that are important to you without pain and to reduce load on the CMC joint.

So, if you’re experiencing any base of thumb arthritis pain, don’t wait.  Contact The Hand Recovery Centre today and get back to what you love sooner!

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