Thumb Injruies

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A football player is tackling the ball carrier and his thumb gets caught in the jersey as he drags the call carrier to the ground. The athlete felt a “pop” and he is unable to grip with his hand. This could be a simple thumb metacarpal-phalangeal sprain (M-P) commonly known as “game-keeper’s thumb” or an avulsion fracture of the ligament.

The injury evaluation should begin with a detailed history. Simple questions such as: how did the injury occur; which direction did the thumb displace; did the athlete “pop it back into socket;” and did he feel a “pop” at the time of injury. These can aid the evaluator in determining the proper course of treatment for the injury. Also look for obvious deformity, swelling, or changes in skin appearance.

If the M-P joint is dislocated, qualified medical care professionals can attempt on-site relocation. If repeated attempts to relocate the thumb are unsuccessful, the injury may require surgery.  This is referred to as a Stenner lesion or “key-hole” injury.

With any dislocation, vascular integrity should be assessed. This can be accomplished by checking for proper capillary refill. Also a neurological exam should be performed to rule out any damage. If the reduction is carried out, the athlete will require orthopaedic evaluation to determine if a fracture is present and to determine the appropriate course of treatment.

M-P Sprain

This X-Ray shows a M-P injury that involves an avulsion fracture of the ligament from the metacarpal. This injury needs to be treated properly so that the athlete does not have debilitating injury.

Performing ligament stress tests to determine the integrity of the ligament assesses this injury. The adjacent picture shows this test. The thumb is abducted while the metacarpal is held in place.

Movement greater than the opposite side is indicative of the injury. The relative amount of movement and end feel determine the severity of the damage. Excessive joint motion is not indicative of isolated ligament damage; an avulsion fracture will display the same abnormal motion. Due to this, an x-ray is necessary to determine if there is a fracture present (as seen on front page).

This x-ray shows abnormal M-P motion without a fracture present. This injury will require proper treatment to prevent an unstable joint in the future.

If the thumb is forcibly adducted more than 60°, a Stenner lesion may occur. In this situation, the collateral ligament slides superficially and proximally to the adductor aponeurosis. The proximal margin of the adductor aponeurosis then slides distal to the insertion of the ligament. This forms a keyhole trapping the head of the metacarpal. Due to this, the joint will fail attempts at relocation. Surgery must be performed to correct this dislocation.

Avulsion Injuries

The inability to fully extend the last joint of the thumb may be the result of an avulsion or avulsion fracture of the extensor tendons. This injury typically occurs when the joint is forcibly flexed while actively attempting to extend the joint. The injury mechanism most commonly seen is a result of the thumb being caught in a football jersey while blocking or tackling. This results in a tearing of the extensor tendon from its attachment. This is also a surgical case; the tendon must be reattached so that normal function of the joint is restored.

All of these injuries require immediate medical attention. Some injuries that do not are subungual hematoma (blood under the nail), torn nails, and small lacerations. All of these injuries are common in athletics and do require proper treatment to prevent complications.

Nail Injuries & Cuts

The subungual hematoma is extremely painful and can result in infection and loss of the nail if not treated properly. A direct blow to the tip of a finger can cause a contusion of the nail bed resulting in a hematoma. This blood causes great pain and pressure. Draining the blood can relieve this. This is accomplished by using a nail drill or heated straight pin. In both cases the implement is used to make a hole in the nail so that the accumulating blood can escape. This results in a decrease in the pain and may save the nail.

If the blood, and resulting pressure, is not removed the nail may fall off. This exposes the sensitive nail bed to repeated trauma and possible infection. After removal of the blood, the nail and surrounding tissue needs to be cleaned and treated like any open wound.

Lacerations should be cleaned and dressed appropriately. If the laceration is large enough, sutures may be required to close the wound to speed healing.

Nail tears need to be cared for appropriately. This begins with educating athletes as to the proper length of nails. An athlete should keep their nails short and well groomed. A long nail is extremely susceptible to tearing. Also, long nails can result in cuts on teammates or opponents. This greatly increases the chance of transmitting blood-borne pathogens.

Caring for torn nails leads to delays in participation for treatment and blood cleanup. Treatment for nail tears includes smoothing the rough edge, cleaning and appropriate dressing application.

©2000 - 2006 David Edell

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM