From the Guidelines
Treatment for a thumb stuck in extension should prioritize conservative measures, including resting the thumb, applying ice, and using over-the-counter anti-inflammatory medications, as well as gentle stretching exercises to maintain mobility, as recommended by recent guidelines 1. When considering treatment options, it's essential to prioritize approaches that promote normal movement patterns and resting postures, rather than resorting to splinting or other interventions that may exacerbate symptoms or lead to complications such as muscle deconditioning or learned non-use 1. Key considerations for treatment include:
- Resting the thumb and avoiding activities that cause pain
- Applying ice to the affected area for 15-20 minutes several times daily to reduce inflammation
- Using over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) to manage pain and swelling
- Gentle stretching exercises to maintain mobility, such as slowly and gently bending the thumb toward the palm several times daily
- Considering a splint worn at night to maintain proper positioning, but weighing the potential benefits against potential harm, such as increased attention and focus on the area, accessory muscle use, or immobilization leading to muscle deconditioning 1. It's also important to note that exercises aimed at improving joint mobility, muscle strength, and thumb base stability can be beneficial, as suggested by recent recommendations for the management of hand osteoarthritis 1. However, the most recent and highest-quality study on functional neurological disorder 1 provides the most relevant guidance for treating a thumb stuck in extension, emphasizing the importance of promoting normal movement patterns and avoiding interventions that may exacerbate symptoms.
From the Research
Treatment Options for Thumb Stuck in Extension
- There are various treatment options available for a thumb stuck in extension, including nonsurgical and surgical interventions 2.
- Nonsurgical interventions may include orthotic devices, such as splints or braces, to help stabilize the thumb and promote healing.
- Surgical interventions can be grouped into four main categories: volar plate advancement/capsulodesis, tendon transfer and tenodesis, sesamoidesis, and arthrodesis 2.
Understanding Thumb Movement and Extension
- The thumb has a unique range of movement, including flexion, extension, anteposition, retroposition, and opposition 3.
- The range of movement of the thumb can be affected by various conditions, such as thumb carpometacarpal (CMC) joint arthritis, which can cause a loss of extension and adduction 4.
- A study on the range of movement of the thumb found that the mean range of movement of the interphalangeal joint (IPJ) was flexion of 88° and extension of 12°, while the metacarpophalangeal joint (MCPJ) had a mean range of movement of flexion of 60° and extension of 8.1° 3.
Relevant Studies and Findings
- A study on the management of thumb metacarpophalangeal hyperextension in the setting of thumb basal joint arthritis found that surgical intervention is based on both the degree of deformity present and the surgeon's preference 2.
- Another study on the effectiveness of orthotic devices in the treatment of Achilles tendinopathy found that foot orthoses were equivalent to physical therapy, and equivalent to no treatment, in treating mid-portion or insertional Achilles tendinopathy 5.
- A review of physical therapy for tendinopathy found that low-level laser therapy (LLLT) showed a pooled improvement in pain reduction and grip strength, and that moderate-quality evidence may support the use of LLLT, extracorporeal shockwave therapy, and eccentric exercise in treating tendinopathy 6.