From the Guidelines
The treatment for a thumb stuck in fixed extension should prioritize strategies that encourage normal movement patterns and resting postures, avoiding splinting as a first-line approach due to potential harm, as suggested by the occupational therapy consensus recommendations for functional neurological disorder 1. When addressing a thumb stuck in fixed extension, it's crucial to consider the underlying cause, which could be related to functional dystonia or other movement disorders. The goal is to restore normal movement and function while minimizing the risk of exacerbating symptoms or causing further complications.
Key considerations in managing this condition include:
- Encouraging optimal postural alignment at rest and within function, considering a 24-hour management approach 1.
- Avoiding postures that promote prolonged positioning of joints at the end of range, such as full extension of the thumb 1.
- Implementing strategies that reduce muscle overactivity, pain, and fatigue, such as muscle relaxation techniques and supporting the affected limb when at rest 1.
- Addressing associated problems of pain and hypersensitivity, which can contribute to the development and maintenance of the condition 1.
Given the potential risks associated with splinting, including increased attention and focus on the area, accessory muscle use, compensatory movement strategies, immobilization leading to muscle deconditioning, learnt non-use, and increased pain 1, it is recommended to explore other interventions first. If splinting is considered, it should be approached with caution, and the individual should be closely monitored for any adverse effects, with the option to discontinue use if necessary 1.
From the Research
Treatment for Thumb Stuck in Fixed Extension
- The treatment for a thumb stuck in fixed extension is not directly addressed in the provided studies, which primarily focus on flexor tendon injuries and boutonniere deformity.
- However, the study by 2 discusses the treatment of stiff fingers, including those with extension deformities, and suggests that the mainstay of treatment is directed hand therapy with exercises and splinting to mobilize stiff joints.
- Operative interventions are offered after gains from therapy have been exhausted, as stated in the study by 2.
- Additionally, the study by 3 presents a management technique using relative motion splinting for early motion following acute repair of boutonniere injuries, which may be applicable to other types of finger deformities, including fixed extension of the thumb.
- The use of serial casting and relative motion flexion splinting, as described in the study by 3, may be considered as a treatment option for a thumb stuck in fixed extension, although this is not explicitly stated in the study.
Key Considerations
- Accurate identification and correction of pathologic structures are essential for effective treatment, as noted in the study by 2.
- Early mobilization and hand therapy are crucial for improving range of motion and preventing further complications, as emphasized in the studies by 4 and 3.
- A thorough understanding of the anatomical and technical considerations involved in treating finger deformities is necessary for successful treatment, as discussed in the studies by 5, 6, and 4.