MANUAL MINORS
Thumb dislocations occur when the joint surfaces separate, typically affecting the metacarpophalangeal (MCP) or interphalangeal (IP) joints. These injuries are often caused by severe hyperextension or abduction forces, such as falls onto the hand or direct trauma. The thumb may present with deformity, intense pain, swelling, and an inability to move.
Diagnosis
Diagnosis is based on a trauma history, visible deformity, severe pain, and limited thumb function. X-rays are essential to confirm the dislocation, assess its severity, and rule out associated fractures.
Differential Diagnosis
Condition | Key Differences |
|---|---|
First metacarpal fracture | Visible fracture line on X-ray with localised severe pain. |
Ulnar collateral ligament sprain | Pain without visible bone displacement, possible joint instability. |
Bennett fracture-dislocation | Intra-articular fracture at the base of the first metacarpal with joint displacement. |
Thumb interphalangeal dislocation | Displacement between the thumb’s phalanges, not at the MCP joint. |
Emergency Management
Immediate immobilisation of the thumb with a splint or cast, avoiding unnecessary manipulation.
Administration of analgesics and anti-inflammatory medications for pain control.
Closed reduction under local anaesthesia or sedation, using careful techniques to realign the joint if no fractures are present.
Post-reduction X-rays to confirm joint alignment.
Immobilisation with a splint to protect the reduced joint.
Definitive Treatment
Simple dislocations can be treated with immobilisation for 2-4 weeks, followed by physiotherapy to restore thumb mobility and function. In cases of unstable dislocations, ligament damage, or associated fractures, surgery may be required to repair tissues and stabilise the joint.
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