Diagnose a Broken Thumb

Thumb fractures can range from fairly straightforward, clean breaks all the way to multiple fractures along a joint that require surgery to repair. Since injuries to a thumb can have lifelong effects on everything from eating to your occupation, the injuries should always be taken seriously.[1][2] Learning the symptoms of a broken thumb and what to expect regarding treatment options is essential to properly recovering from the injury.

Steps

Identifying a Broken Thumb

  1. Note any severe pain in the your thumb. It is normal to experience severe pain right after you break your thumb. The pain happens because your bones have nerves surrounding them. When a bone breaks, it can irritate or compress the surrounding nerves, which causes pain. If you don’t experience severe pain right after the injury, there is a chance that your thumb is not broken.[3]
    • You will also experience severe pain if something touches your thumb or when you try to bend it.
    • Generally, the closer the pain is to the joint where your thumb meets the rest of your hand (closest to the webbing between your thumb and forefinger), the more cause for concern and potential complication for the injury.
  2. Look for any deformities at the site of the injury. You should look to see if your thumb looks normal. Is it bent at an odd angle or twisted in some strange way? You should also check to see if there is any bone protruding out of the skin. If you notice any of these characteristics, it is very likely that you have broken your thumb.[4]
    • Your thumb will also most likely have bruises on it, which is a sign that the capillaries in the tissue of the thumb have broken open.[5]
  3. Try to move your thumb. If you have broken your thumb, moving it will cause you serious and severe pain. Your ligaments connecting your bones will also most likely be unable to function properly, which can also make it difficult to move your thumb.[4]
    • In particular, check to see if you can move your thumb backwards. If you can move it backwards without pain, you probably have a sprain rather than a broken bone.
  4. Pay attention to any numbness, tingling, or coldness you feel in your thumb. Aside from causing pain, compressed nerves can also make your thumb go numb. Your thumb might also begin to feel cold. This is because a fractured bone or a lot of swelling can block the blood vessels that carry blood into your thumb and surrounding tissue.[6]
    • Your thumb might also turn blue if it is receiving very little or no blood.
  5. Look for severe swelling around your thumb. When you break a bone, the area around it will swell up due to inflammation. Your thumb will begin to swell five to ten minutes after the injury has occurred. After the thumb swells, it may begin to stiffen.[4]
    • The swelling in your thumb might also affect the closest fingers to your thumb.

Having a Doctor Assess Your Thumb

  1. Visit your doctor or go to the emergency room. If you think you have broken a thumb, you should go to the emergency room so that a professional can set it. If you wait too long, the swelling caused by the broken bone can actually make it too difficult to realign the bones, which means that your thumb could be permanently bent.[7]
    • In addition, broken thumbs in children can permanently affect their growth by damaging their growth plates.
    • Even if you suspect the injury might be a sprain (torn ligament) rather than a bone fracture, you should still see a doctor for an accurate diagnosis. Additionally, some serious sprains can still require a hand surgeon to repair. You should ultimately leave the final diagnosis and treatment decisions to a medical professional.[8][9]
  2. Submit to a physical examination. In addition to asking questions regarding the symptoms from Part One, the doctor will also physically examine your thumb. He may test your strength and movement in the thumb by comparing it to that of your uninjured thumb. Another test includes touching the tip of your thumb to your index finger before applying pressure to the thumb to check your weakness.[8]
  3. Get an x-ray taken of your thumb. The doctor will likely order x-rays of your thumb from a variety of angles. This will not only confirm that diagnosis, but it will also show the doctor exactly how many fractures your thumb has sustained, which will assist in determining the best treatment option. The angles for the x-rays include:[10]
    • Lateral: The lateral view is an x-ray with the hand resting on its side, so that the thumb is up.
    • Oblique: The oblique view is an x-ray with the hand tilted, resting on its side, so that the thumb is up.
    • AP: The AP view is an x-ray of your hand in a flattened position, from above.
  4. Talk to your doctor about getting a computed tomography (CT) scan. A CT scan can also be referred to as a computerized axial tomography (CAT) scan. A CT scan uses x-rays and a computer to create images of what the inside of your body parts (in this case, your thumb) look like. This way, your doctor can get a better idea of what the break is like and the best way to go about fixing it.[11]
    • Tell your doctor if you are pregnant because CT scans might cause harm to the fetus.
  5. Have your doctor diagnose the type of break. Once your doctor has run the relevant tests, she will diagnose the specific type of fracture you have sustained. This will determine the complexity of the treatment options available.[3]
    • Extra-articular fractures are those that take place away from a joint along the length of one of the two bones in the thumb. While painful and requiring six weeks to heal, these fractures do not typically require surgical intervention.[3]
    • Intra-articular fractures take place along the joint, often requiring surgical intervention to help the patient retain as much movement in the joint after recovery as possible.[3]
    • Of the intra-articular thumb fractures, the two most common are a Bennetts fracture and a Rolando’s fracture. In both, the thumb fractures (and likely dislocates) along the carpometacarpal joint (the thumb joint closest to the hand).[12] The major difference between the two is that a Rolando’s fracture involves three or more bone fragments that require realignment, and while a Bennetts fracture may occasionally forego surgery, a Rolando’s fracture almost always necessitates surgical treatment.[13][14]

Treating a Broken Thumb

  1. See an orthopedic surgeon. An orthopedist will look at your x-rays and other tests to help determine the best treatment option. He will take into account the type of fracture (intra- or extra-articular), as well as the complexity (Bennett's versus Rolando’s fractures).[15]
  2. Ask about non-surgical options. In relatively straightforward cases (such as an extra-articular fracture) the doctor may be able to replace the fracture fragments manually without surgery.[15] She will provide anesthesia before attempting to realign the fragments.
    • This method (also referred to as a closed reduction) typically consists of the doctor pulling and tugging along the break to realign it while using a fluoroscopy (continuous, realtime x-raying) to see when the fragments are realigned.[15]
    • Note that some Rolando’s fractures, especially those where the bones are shattered into too many pieces to screw or pin together, may also be treated in this method with the surgeon molding the fragments to the best of his ability (known as an open reduction).[16]
  3. Consider surgical treatments. For intra-articular fractures (such as Bennett's and Rolando’s fractures), your orthopedist will usually suggest surgery. The specific type of surgery will depend on the complexity of the fracture(s). Typical options include:[16][17]
    • Using fluoroscopy to place wires through the skin to realign the fragments, known as external fixation. This option typically pertains to Bennett's fractures where the fragments have remained very close together.
    • Having a surgeon open the hand to place small screws or pins into the bones in order to keep them properly aligned. This is known as internal fixation.
    • Potential complications from surgical options include nerve or ligament injuries, stiffness, and increased risk of arthritis.[18]
  4. Immobilize the thumb. Whether your particular case calls for a surgical or non-surgical option, the doctor will place your thumb in a spica cast to immobilize it and keep all of the fragments perfectly in place during the recovery period.
    • Expect to wear the cast anywhere from two to six weeks, with closer to six being the norm.[4]
    • Your doctor may also schedule follow-up appointments during this time.
  5. See a physical therapist. Depending on the length of time you spend in the cast and your mobility upon the removal of the cast, your doctor may recommend that you see a physical or occupational therapist. A therapist will be able to provide a number of flex and grip exercises to rebuild strength due to atrophied muscle during the immobilization period.[15]

Tips

  • Whether it's break or a sprain, it is always best to go to the hospital and have your thumb cared for properly.

Warnings

  • While this article offers medical information regarding a broken thumb, it should not be used as medical advice. Always see your doctor for a proper diagnosis and treatment options for any potentially serious injury.
  • Tell your doctor if you are pregnant before having an x-ray done. Infants are more sensitive to x-rays, so it is best to avoid this method of determining if your thumb is broken or not.

Related Articles

Sources and Citations

  1. ↑ Brian Carlson MD and Stephen Moran MD. American Society for Surgery of the Hand, May June 2009 Volume 34 Issue 5 945-952
  2. ↑ Skinner, H, Current Diagnosis and Treatment of Orthopedics 5th Edition, Chapter 9, Hand Surgery, 2008
  3. ↑ 3.0 3.1 3.2 3.3 Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
  4. ↑ 4.0 4.1 4.2 4.3 http://orthoinfo.aaos.org/topic.cfm?topic=a00011
  5. ↑ http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/bone-conditions-treatment/hand-fractures-symptoms/
  6. ↑ Stark, C. D., & Bowers, E. S. (2010). Living with sports injuries. New York: Facts On File.
  7. ↑ Plancher, K. D. (2006). MasterCases Hand and Wrist Surgery: Hand and Wrist Surgery. New York: Thieme Medical Publishers.
  8. ↑ 8.0 8.1 C, Tsiouri et al, Hand, Injury to the Ulnar Collateral Ligament of the Thumb, 2008 March, 4(1) 12-18
  9. ↑ Brian Carslon MD , Steven Moran MD, Thumb Trauma : Bennetts, Fracure, Rloando’s fractrues, and Ulnar Collateral Ligament Injuries, American Society for Surgery of the Hand, May June 2009 Volume 34 Issue 5 945-952
  10. ↑ Foster RJ, Hastings H. Treatment of Bennett, Rolando, and vertical intra-articular trapezial fractures. Clin Orthop Relat Res 1987; 121.
  11. ↑ Lanz, U., Schmitt, R., & Buchberger, W. (2008). Diagnostic imaging of the hand. Stuttgart: Thieme.
  12. ↑ Wheeless, Wheeless Textbook of Orthopaedics, Bennetts Fracture Dislocation, 10, 2012
  13. ↑ Wheeless, Wheeless Textbook of Orthopaedics Rolandos fracture, 10, 2012
  14. ↑ Brian Carlson MD , Steven Moran MD, Thumb Trauma : Bennetts, Fracure, Rloando’s fractrues, and Ulnar Collateral Ligament Injuries, American Society for Surgery of the Hand, May June 2009 Volume 34 Issue 5 945-952
  15. ↑ 15.0 15.1 15.2 15.3 J, Leggit, Acute Finger Injuries Part II, Fractures, Dislocations and Thumb Injuries, American Family Physician, March 1 2006 73 (5) 827-834
  16. ↑ 16.0 16.1 C, Wheeless, Wheeless Textbook of Orthopaedics Rolandos fracture, 10, 2012
  17. ↑ Brian Carlson MD , Steven Moran MD, Thumb Trauma : Bennetts, Fracure, Rloando’s fractrues, and Ulnar Collateral Ligament INjuries, American Society for Surgery of the Hand, May June 2009 Volume 34 Issue 5 945-952
  18. ↑ http://www.eatonhand.com/complic/text10.htm

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