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Thumb Tenosynivitis (De Quervain’s Disease)
This injury is an overuse injury of the tendons in the thumb at the back of the wrist (dorsal aspect of the wrist). Inflammation of the tendons and their surrounding ‘sheath’ is commonly caused by overuse in racquet sports, bowling or extended typing or writing. Symptoms include pain and swelling on the back of the base of the thumb which may extend up into the forearm or down into the thumb as well as a creaking sensation when moving the thumb. Effective treatment must be sought as well as rest from the aggravating activity to ensure adequate recovery.
This injury involves a ligament sprain on the inside at the base of the thumb and is one of the most common injuries encountered during skiing. The injury occurs when the skier falls on their hand whilst holding a ski pole with their hand in the strap.
The strap forces the thumb upwards and backwards, damaging the ligament on the inside of the thumb. Symptoms include pain around the base of the thumb and thumb web and extensive bruising and swelling around the thumb web. Immobilisation and swelling management are important.
Thumb (CMC) Joint Arthritis
This is the most common location for arthritis in the hand. It is due to wear and tear with use of the thumb. There is no cure for arthrits. Treatment falls into three categories:
Surgery, used as the last resort when conservative treatment has failed, consists of a joint replacement using the patient’s normal body tissues. This involves excising the arthritic bone and replacing it with a tendon taken from the wrist which is rolled up into a ball and used as a spacer and a portion of it is used to reconstruct the ligament. This is done through a small incision at the base of the thumb and a smaller incision at the base of the wrist to harvest the tendon used for the graft. It is an outpatient procedure performed under axillary block where only the arm goes to sleep. The patient is immobilized in a splint for two weeks, then a thumb spica cast for two weeks and then uses a removable custom made splint for two months while they are undergoing therapy for their thumb.
The first month is to regain range of motion and the second month to regain strength. Physiotherapy is very imprtant in this stage of rehabilitation. A three month postoperative rehabilitation protocol need to be undertaken. Patients have a very good success rate with this surgery.
Before surgery is considered, conservative treatment is attempted which is aimed at alleviating the symptoms of arthritis. This consists of use of a splint, possible anti-inflammatory medications, possible icing, and occasionally a cortisone injection which usually give good but temporary relief
The scaphoid is the most common carpal (wrist) bone injured and is located at the base of the thumb. Fractures of the scaphoid lead to significant long term physical problems. They are commonly seen in young athletes of many different sports
Scaphoid fracture is commonly caused by a fall on an outstretched hand. Pain and swelling quickly result in the thumb side of the wrist. Should you experience these symptoms it is very important to seek treatment as soon as possible. Early detection by a thourough physical examination, x-ray and/or bone scan will help to ensure your injury is managed properly. Once the diagnosis of a fracture has been established, several treatment options may be considered. These may include immobilisation in a cast, or in sever cases where the bone is separated, surgery may be required to reunite the bone with a pin.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
Exercises should be 3 sets of 8-12 repetitions.