Thumb Sprains: Treatment Options

Thumb Sprains: Treatment Options

This video will provide an overview of treatment options for thumb sprains. Thumb sprains result from injury to the ulnar collateral ligament, or U C L. In an anatomy review, the UCL connects the thumb bone to the metacarpal bone just below. It is important in stabilizing the thumb during pinching and grasping activities. An injury to this ligament is often called a skier’s thumb.

The treatment options for a torn UCL depend on the severity of the injury. It is essential to differentiate between a partial and a complete tear of the ulnar collateral ligament to determine if the injury should be treated with or without surgery. Regardless, the joint will feel unstable if left untreated and may develop arthritis.

If a tear to the UCL is partial, treatment without surgery will be advised. Treatment without surgery consists of bracing or casting in a position that keeps the joint stable and slightly bent. The scientific literature varies on the time spent in an immobilization device. However, 4-6 weeks is a typical duration, depending on the amount of looseness, or laxity, in the joint during examination. Hand therapy will also be ordered as part of this treatment pathway.

If the ligament does not heal without surgery or, the ligament is completely torn, surgery will be advised. Surgical treatment may include repair or reconstruction, with or without additional suture support, or a joint fusion if arthritis is present. Repair, or repair with additional suture support, may be offered if the injury is diagnosed early. Here, the torn ligament is repaired, and an additional suture is secured into the nearby bones. It is placed across the repaired ligament for extra support.

If diagnosis is delayed, the ligament may require reconstruction, especially if insufficient tissue is left in the damaged ligament to repair it. Reconstruction requires a tissue graft for the repair. In the past, this was a complicated surgery. However, it has now been improved using bone anchors.

One other variation of this injury that requires similar surgical technique is a Stener lesion. Stener lesions present immediately as a painful bump with swelling to the inside of the thumb due to a trapped portion of the torn UCL. Surgical options for this injury have evolved to minimally invasive procedures that allow patients to quickly regain function of their thumb after surgery.