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October 25, 2007

Thumb Avulsion Fracture

So not cool. About a month ago, I went to Sams Club and was going to grab a shopping cart. When I went to grab it, I snapped my thumb back and I thought I hyperextended it. Well, two weeks later, it didn't get better so I went to see my doctor. He sent me for x-rays and said that I will probably need to see a hand surgeon. Well, now I know why:

Here is a handy dandy website that explains the strange foreign body that I noticed on my x-rays:

The joint that is affected at the bottom of the thumb is called the metacarpophalangeal, or MCP, joint.Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. If the force is too strong, the ligaments are damaged. They may even tear completely. A complete tear is also called a rupture.

When the collateral ligaments tear, the MCP joint becomes very unstable. It is especially unstable when the thumb is bent back. If one of the ligaments pulls away from the bone and folds backwards, it won't be able to heal in the correct position. When this happens, surgery is needed to fix the ligament.

Sometimes the ligament itself will not tear but instead pulls a small piece of bone off the base of the thumb where it attaches. This is called an avulsion fracture. This can also lead to an unstable thumb joint if the fracture does not heal correctly.

Avulsion Injury to Thumb

Here is an example x-ray similar to mine. It is also often called "Gamekeeper's Thumb" because the injury commonly occurs to soccer goalkeepers.

Gamekeeper's Thumb

When the ulnar collateral ligament is injured, the MCP joint becomes painful and swollen, and the thumb feels weak when you pinch or grasp. You may see bruise-like discolorations on the skin around the joint. The loose end of the torn ligament may form a bump that can be felt along the edge of the thumb near the palm of the hand. A torn ligament makes it difficult to hold or squeeze things between your thumb and index finger.

If the ligaments are only partially torn, they usually heal without surgery. Your thumb will be immobilized for four to six weeks in a special cast, called a thumb spica cast. After that, you will begin to do exercises to regain your range of motion and to strengthen your grip.

Getting treatment soon after an injury to the collateral ligament of the thumb may improve your ability to regain strength and range of motion.

If the ligaments are completely torn, you will most likely have surgery to repair them. A torn ligament cannot fully heal itself. Surgery for the thumb collateral ligaments is usually done as an outpatient procedure, meaning you will probably go home the same day as the surgery.

In the surgery, your doctor will make a small V- or S-shaped cut over the back of the MCP joint of the thumb. This helps isolate and protect the nerve branches running up your thumb. Your doctor will then cut through a sheet of tissue called the adductor aponeurosis. This helps expose the MCP joint and the ligaments. The area around the injury is examined for any soft tissue damage. Your surgeon then repairs the ligaments with stitches that anchor them back to the bone.

Patients who are treated nonsurgically with a thumb spica cast start an exercise program when the cast is removed, usually after four to six weeks. Motion and strength usually improve within another two to four weeks, allowing people to get back to normal activity.

If you have surgery, you will be placed in a thumb spica cast for four weeks. Some doctors will take the spica cast off at four weeks and then place your thumb in an immobilizing splint for another two weeks. Some patients work with a physical or occupational therapist to help regain range of motion and strength in the thumb. Most patients are able to return to normal activity three months after their surgery.

Yeah, so this totally sucks. First, it is going to affect my skiing this winter. Second, it will affect my blogging. Finally, it will affect my job. But I get paid when on disability, so this isn't the worst thing in the world. No Xbox360. No typing. No work.

Now, there is always the possibility that I am misinterpreting the foreign body floating in my thumb x-ray after a valgus force and the accompanying pain that has lasted almost a month. I have a consult with a hand surgeon the Tuesday before Thanksgiving.

Posted by Justin at October 25, 2007 11:12 PM

Comments

On the brighter side of things, this is also known as "skiers thumb". It sounds better that way, now to fix the story on how it happened to fit with the better name.

Posted by: Oft-piste at October 26, 2007 10:20 AM

i had the similar thing happen to me, however i didnt take care of it for 8 months, now i have permanent damage done to my right thumb. i had no insurance at the time, and it was my first broken bone, so i was afraid to go to the hospital... i wish i could post a pic on this site to show all of you... it looks like it has a marble in between the joint. email me for a picture, i will be glad to show you.

Posted by: Steven B at December 30, 2007 05:38 PM