What is the recommended aftercare for a thumb dislocation?

Thumb Dislocation Aftercare

The recommended aftercare for a thumb dislocation involves immobilization in a thumb spica cast or splint for approximately 4 weeks, followed by progressive rehabilitation exercises to restore mobility and strength.

Initial Management After Reduction

After a successful reduction of the thumb dislocation, proper immobilization is crucial for healing:

• Apply a thumb spica cast or splint that immobilizes both the carpometacarpal (CMC) and metacarpophalangeal (MCP) joints 1, 2
• Maintain immobilization for approximately 4 weeks to allow proper ligament healing 2
• Ensure the thumb is positioned in slight abduction during immobilization to promote optimal healing 1

Monitoring During Immobilization Period

Regular follow-up is essential during the immobilization period:

• Schedule follow-up evaluation at 1-2 weeks post-reduction to:
  • Confirm maintained reduction with radiographs
  • Check for proper splint/cast fit
  • Assess for complications such as neurovascular compromise
• Monitor for signs of complications including:
  • Persistent pain
  • Swelling
  • Numbness or tingling
  • Skin irritation from the cast/splint

Rehabilitation Protocol

After the immobilization period (typically 4 weeks), begin a progressive rehabilitation program:

1. Early Phase (Weeks 4-6):

   • Begin gentle active range of motion exercises
   • Apply local cold therapy for 20 minutes with periodic interruptions to manage pain and swelling 3
   • Initiate light activities of daily living while avoiding forceful gripping or pinching

2. Intermediate Phase (Weeks 6-8):

   • Progress to more active range of motion exercises
   • Begin gentle strengthening exercises
   • Apply local heat before exercise to relieve pain and stiffness 3
   • Continue to avoid activities that place significant stress on the thumb

3. Advanced Phase (Weeks 8-12):

   • Progress to resistive exercises for strengthening
   • Gradually return to normal activities as tolerated
   • Consider custom orthosis for protection during high-risk activities 3

Special Considerations

For Simple Dislocations

• Closed reduction and immobilization is typically sufficient for uncomplicated dislocations 2
• Monitor for recurrent instability, which may indicate ligamentous damage requiring surgical intervention 4

For Complex Dislocations

• If instability persists after reduction, surgical intervention may be necessary 4
• Early ligamentous reconstruction may be considered for cases with significant instability to prevent long-term complications 4

Warning Signs Requiring Immediate Attention

Instruct patients to seek immediate medical attention if they experience:

• Sudden increase in pain
• New onset numbness or tingling
• Signs of infection (increased warmth, redness, drainage)
• Cast/splint becomes loose or damaged
• Evidence of recurrent dislocation

Long-term Follow-up

• Evaluate at 3 months post-injury for:
  • Full range of motion
  • Grip and pinch strength (expect approximately 10-13% decrease compared to uninjured side) 4
  • Joint stability
• Consider radiographic assessment to evaluate for early degenerative changes

Common Pitfalls to Avoid

1. Inadequate immobilization period - Premature removal of immobilization can lead to recurrent instability
2. Overly aggressive early rehabilitation - May cause re-injury or chronic instability
3. Failure to recognize persistent instability - Can lead to chronic pain and early arthritis
4. Neglecting strengthening exercises - Results in prolonged weakness and functional limitations

Proper aftercare following thumb dislocation is essential to restore function and prevent long-term complications such as chronic instability, weakness, and post-traumatic arthritis.