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Solution for Difficult Problems: Thumb Dislocation

Digital blocks are not routine, but do one as needed or if the patient has a laceration, needs extensive wound care, or could benefit from a block. Note: Skin repairs are done after the dislocation is reduced. Longitudinal traction method of joint reduction is used to treat the injury. Distract the patient with conversation while holding the injured area. It helps to make eye contact. Mimic the path by which the initial injury occurred, slightly exaggerating the deformity that is present. Pull the finger forcefully and quickly in the opposite direction as you push the joint back into position.

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Articles of Interest

Thumb Metacarpophalangeal dislocation

Simple thumb MCP joint dislocation are in extension and reducible whereas complex dislocations are in bayonet apposition and not easily reducible. It is extremely important to obtain radiographs prior to attempting reduction to clarify whether the reduction should be attempted or referral to hand surgeon. Emergency medicine physician should reduce the dislocation once confirmed a simple dislocation without associated open joint, fracture or entrapped volar plate.

Dislocated Thumb Overview

Thankfully, this type of injury rarely occurs unless you are an athlete or are in a high-impact accident. However, fingers (including the thumb and particularly the middle joint), are some of the most commonly dislocated joints. There are three different joints in the thumb that can be dislocated, depending on where and how impact occurs.

How to Treat a Dislocated Thumb

Thumb joint dislocations occur when the soft tissue (or ligament) that holds the joint is torn. Or when a significant force causes the ligaments to give way. The bones then move and eventually slip out of their normal placement. This is a common injury in sports such as basketball and volleyball, where hands are involved. When catching or blocking a ball, the finger bone can easily get jammed. Once an outstretched finger gets hit, it hyperextends backward. Sports with the highest rates of hand injuries also include football and gymnastics.

Management of Acute and Chronic Thumb CMC Joint Dislocations

Isolated dislocations of thumb CMC joints are rare injuries with serious functional implications. Patients suffering these injuries will have decreased pinch and grip strength. A high-energy, axially directed force on a flexed thumb typically causes dislocation.

Metacarpophalangeal joint dislocation

Metacarpophalangeal joint dislocations account for ~3-5% of all dislocations. The thumb is the most commonly affect digit, followed by the little finger.

SplintER Series: A Rare Cause of Traumatic Thumb Pain

The CMC dislocation should be anesthetized with an intra-articular injection, and then closed reduction should be performed with traction. Immobilize the joint with a thumb spica splint with the first metacarpal held in abduction and extension with the wrist in pronation. Closed reduction is often unstable. The patient should have follow-up arranged with a Hand Specialist within 3-4 days.

Thumb CMC Dislocation

Thumb CMC Dislocations are rare injuries that occur due to axial force on a flexed thumb. Diagnosis is clinical and can be confirmed by orthogonal radiographs. Treatment is closed reduction and immobilization with unstable injuries requiring surgical stabilization.

Thumb Dislocation and Fracture

Dislocations of the thumb are generally best corrected with open reduction in order to directly reposition the tissue and bone. Failure to sufficiently correct the dislocation of a thumb could result in instability, chronic joint stiffness, an inability to flex and extend the thumb in a normal way – and eventually arthritis.

Thumb Interphalangeal Joint Dislocation

Closed reduction of the IP joint is usually successful, especially with closed injury. The most common reason for failed reduction of the IP joint is avulsion of the volar plate from the proximal phalanx with interposition into the joint