Sprained/Jammed Thumb

A sprained thumb, also referred to as skier’s thumb, is a fairly common condition that involves damage of the connective tissues in the thumb. When the term “sprained thumb” or “thumb sprain” is used, it typically means an injury to the main ligament of the thumb, which is called the ulnar collateral ligament. “Jammed thumb” is a more general term that may be used to describe how the injury occurred, and in most cases it represents the same injury as a sprained thumb. A stable thumb is extremely important in order to perform many activities that require pinching and grasping, and a sprained thumb can significantly weaken your ability to perform these tasks.

What Causes a Sprained Thumb?

The thumb consists of two small bones called phalanges, which join each other at the two joints you can see any time you bend your thumb. Each of these joints contains strong connective tissues—including ligaments, cartilage and the joint capsule—that wrap around the ends of these bones to keep them stable and cushion them from rubbing against each other during activities. The ligament that connects the base of your thumb to the lower bone is called the ulnar collateral ligament, and when a force of any sort causes it to stretch too far in any direction, it results in a sprained thumb.

In most cases, a thumb sprain occurs due to a specific incident that causes the thumb to bend out of its normal range of motion, usually in a backwards direction. For athletes of certain sports (e.g. basketball, rugby, volleyball, soccer goalkeepers), this may result from making contact with another player, the ball or the ground, as it is our natural tendency to extend our arms to protect ourselves during a fall. Skiing is also responsible for many thumb sprains, as the impact from a fall or the hand getting caught in a pole that’s planted in the snow can damage the ligament as well. Traumatic events such as these are most commonly responsible for stretching or tearing the ulnar collateral ligament, but in rare cases, thumb sprains may also occur due to repetitive strain that’s associated with overuse of the thumb.

What are the Symptoms?

Depending on the severity of the sprain, symptoms may or may not be felt right away. The most common symptoms of a thumb sprain are pain, swelling and tenderness at the base of the thumb over the ulnar collateral ligament. Pain is typically aggravated during activity or anything that causes the thumb to move backwards, though pain and stiffness may also occur during rest periods. In more severe sprained thumbs, swelling and bruising will develop almost immediately. These symptoms may be noticed on the front, back or sides of the affected thumb, and will collectively weaken your ability to grasp items between the thumb and index finger. When the injured thumb joint also feels lax and/or unstable, it may suggest a total rupture of the ligament, which requires surgery.

What is the Treatment?

As with any injury, after a thumb sprain you should see a physical therapist or physician to confirm the diagnosis and receive treatment recommendations. Your physical therapist will perform a thorough evaluation to determine if a sprain—or some other injury—is present, and how severe it is. In some cases, an X-ray or some other tests may be needed to rule out a more serious injury like a fracture or complete ligament tear. In general, most sprained thumbs will take about 4-6 weeks to heal completely, but if it’s not treated properly, there will be a greater risk for re-injury and permanent instability of the thumb. For most thumb sprains, a course of conservative (non-surgical) rehabilitation is recommended that typically consists of the following:

RICE – The Simplest Form of Home Remedy

• Rest: avoid dangerous activities and protect the thumb from anything that may cause it further harm
• Ice: apply an ice pack or cold compress to the injured thumb for 10-15 minutes every hour for the first 24-48 hours
• Compression: use a compression bandage, support or brace to reduce swelling; the DonJoy ComfortFORM Wrist and Thumb Support and AirCast A2 Wrist Brace with Thumb Spica are both great for keeping the thumb immobilized and preventing it from bending backwards
• Elevation: keep the hand elevated intermittently for the first 24-48 hours to reduce swelling

Physical Therapy

Your physical therapist will provide you with a customized treatment program to heal your sprained thumb that will vary for each patient. The recommended brace, bandage or support should be worn at all times in the early stages after the injury, and once inflammation subsides, it can be removed to perform exercises:

Mobility Exercises

Mobility exercises are used to improve the flexibility of the thumb that may have been lost due to immobilization

Strengthening Exercises

It is important to build back the strength of the thumb and surrounding region; therapeutic putty and hand exercise balls are especially effective for these types of exercises, as are grip and thumb strengthening devices

Other

Education on how to modify dangerous activities, soft-tissue massage and ultrasound may also be used to address symptoms

Returning to Activity

Your therapist will determine when you are ready to return to sports or other activities based on your recovery

Surgery

If the ulnar collateral ligament is completely torn—which is usually detected if there is significant laxity and instability of the thumb—surgery may be needed. Surgery may also be needed if the ruptured ligament becomes entangled in the soft tissue at the base of the thumb. The surgical procedure used in these situations involves reconnecting the ruptured ligament to the bone using wires or sutures, and physical therapy is also required following the procedure.

Can a Thumb Sprain Be Prevented?

It’s impossible to prevent all thumb sprains, but there are some measures you can take to reduce the chances of experiencing one:

• If you’ve already sprained your thumb, be sure complete your rehabilitation program and follow your physical therapist’s advice on rest and returning to activities
• For rugby players, football players, soccer goalies and other athletes, have a medical professional use a thumb brace or preventative tape to tape your thumb before competition
• Skiers should use a thumb brace for additional stability that will help prevent a sprain; it may also be wise to not use the loops on ski poles that can cause a sprain