Injury to the metacarpophalangeal (MCP) joint of the thumb is common in contact and/or ball sports such as skiing, basketball, rugby, football, netball and volleyball.

Any extreme force that pulls the thumb away from the palm of the hand or falling on an outstretched hand (with thumb bent back) can damage the supporting collateral ligaments. In fact, it is often referred to as “Skier’s thumb”, as this injury often occurs when a skier falls down while holding a ski pole. The thumb is forced out and backwards, leading to an injury in the ulnar collateral ligament of the thumb.

Symptoms

  • Pain over MCP joint and in the webspace with thumb movement
  • Swelling over the MCP joint of thumb
  • Weakness and difficulty with pinching, grasping, or holding objects between thumb and index finger
  • May have some discolouration (like a bruise) around the joint
  • Increased laxity and instability in the joint

Immediate Treatment

Immediate treatment following a thumb sprain should consist of the typical acute injury guidelines:

1. Rest the thumb to avoid further movement or stress to be placed on the joint. Taping can help to provide extra support and prevent further damage to the ligaments. Taping is useful immediately after an injury and also as a preventative measure upon returning to sport.

2. Ice the injured area to reduce pain and swelling. This should be done immediately after the injury and over the first few days.

3. Compression using a support bandage will aid with swelling.

Rehabilitation Exercises

Most thumb sprains will take around 3-6 weeks to heal, depending on the severity of the injury. Gradual range of motion (ROM) and strengthening exercises for the thumb should be commenced as soon as the pain and swelling subsides to restore movement, strength and stability to the thumb joint. This will also help with preventing further injury upon returning to sport. Here are some simple ROM and strengthening exercises below – these can be performed passively (ie. other hand holds the injured thumb to assist with movement), or actively (ie. the injured thumb performs the movement by itself). Repeat each 10x, 3 times a day.

  1. Thumb extension (start with thumb in neutral position, and gently bring thumb outwards and backwards as far as possible without pain)
  2. Thumb flexion (start with thumb in neutral, and gently bring thumb in towards the palm as far as possible without pain)
  3. Hand grasp (holding a squeeze ball, grasp the ball in the palm of the hand with the thumb and fingers and squeeze as firmly as pain allows. Hold this position for 5-10 seconds, then relax for 5s. Repeat 10x)
  4. Thumb-finger pinch (holding a small rubber or soft object, pinch the thumb and index finger together as firmly as pain allows. Hold for 5-10s, then relax for 5s. Repeat 10x)

Taping Techniques

Taping is useful as a preventative measure upon returning to sport and provides extra support to the thumb joint to prevent reinjury.

Firstly, a low irritant tape (Fixomull) should be used to protect the skin. Then the more rigid sports tape (Leukoplast) is used on top.

1. Anchor

Place an anchor strip of Fixomull followed by Leukoplast around the lower end of forearm, just below the wrist. This should be applied gently without any pull on the tape and is used as an anchor point for the other tapes.

Thumb Strapping - Anchor

Anchor

2. Spica (Side) Loop

Keeping the wrist and thumb in a neutral position (wrist should be bent backwards slightly – about 30 degrees), start the tape at the level of the anchor on the front of the wrist by following the black arrows. Conclude this thumb taping technique at the level of the anchor by firmly following the white arrows. Do 1 – 3 side loops slightly forward or backward of each other depending on the amount of support required.

Thumb Strapping - Side Loop

Spica

If you wish, you can finish off your taping here by applying a final anchor. However for extra support, you may wish to continue with the following Front and Back loops.

3. Front Loop

Keeping the wrist and thumb in a neutral position (wrist should be bent backwards slightly – about 30 degs), start the tape at the level of the anchor on the front of the wrist by following the black arrows. Conclude this thumb taping technique at the level of the anchor by firmly following the white arrows. Do 1 – 3 front loops slightly forward or backward of each other depending on the amount of support required.

Thumb Strapping - Front Loop

Front loop

4. Back Loop

Keeping the wrist and thumb in a neutral position (wrist should be bent backwards slightly – about 30 degs), start the tape at the level of the anchor on the back of the wrist by following the black arrows. Conclude this thumb taping technique at the level of the anchor by firmly following the white arrows. Do 1 – 3 back loops slightly forward or backward of each other depending on the amount of support required.

Thumb Strapping - Back Loop

Back loop

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