Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb.

The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.

The wound healing effect of aqueous extract from Piper amalago L. in diabetic patient.

Diabetes patients present a complex healing process due to several factors directly linked to their pathology. The use of medicinal plants that aid in tissue repair can bring great benefits to such individuals. This case report describes how the topical application of the aqueous extract produced from the leaves of Piper amalago L. was used to aid the healing of a lacerated wound in the left thumb of a patient with type 2 diabetes mellitus. The aqueous extract of the leaves of Piper amalago L. was prepared in boiling water. During the boiling process the dried leaves were submerged in the boiling water and left for five min. The injured thumb was submerged in the solution and the leaves were placed on the injury. The action of the aqueous extract obtained from the leaves of P. amalago was shown to be promising in the healing of a wound in a patient with type 2 diabetes mellitus. The topical application of the aqueous extract produced from the leaves of P. amalago assisted in the healing of a lacerated wound in the left thumb of a patient with type 2 diabetes mellitus over a period of 15 days.

Ulnar Collateral Ligament Reconstruction of Thumb Metacarpophalangeal Joint With Adductor Pollicis Tendon Using the Wide-Awake Approach.

Injuries to the ulnar collateral ligament (UCL) of the thumb are common and require prompt attention. Diagnostic findings and treatment options differ in acute and chronic injuries of the UCL. Pain and weakness of pinch and grip occur with chronic UCL instability. Various surgical techniques have been described for the treatment of chronic ligament insufficiency at the metacarpophalangeal (MCP) joint of the thumb. These include refashioning of the ligament from capsular remnants, dynamic tendon transfers, tendon advancement, free tendon grafts, and MCP joint fusion. Free tendon grafts offer a reliable method of reconstruction. Fixation is usually achieved by passing sutures through drill holes, using pull out wires, passing the tendon graft through bone tunnels or attaching the tendon graft to a staple. However, a simpler technique using a half-slip of the adjacent adductor pollicis tendon to stabilize the thumb MCP joint can be considered. We demonstrate a simple and effective surgical technique for reconstruction of the UCL at the thumb MCP joint for chronic injury of the ligament, using the adjacent adductor pollicis tendon under a wide-awake approach.

Prevalence and risk factors of thumb pain in Italian manual therapists: An observational cross-sectional study.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) affect physical therapists with loss of health status and social costs. MSD is a relevant problem in upper limb extremities, especially when associated with manual techniques. OBJECTIVE: The study aims to investigate the prevalence and risk factors associated with thumb pain in Italian physiotherapists who perform manual therapy. METHODS: A self-administered questionnaire was sent by email, exploring demographics, thumb mobility, job, thumb pain, manual techniques, aggravating factors, management strategies and consequences of thumb pain. RESULTS: The survey was sent to 523 manual therapists, 219 of which fully completed it. 49.3% of respondents experienced thumb pain at least once in the previous 12 months and 70.8% at least once in their lifetime. Statistically significant associations suggest that within 12 months manual therapists with more than 5 years of experience are less likely to report thumb pain (6-10 years of work: OR = 0.408, 95% CI: 0.215-0.775; 11-20 years of work: OR = 0.346, 95% CI: 0.139-0.859), whereas those who performs trigger point pressure release (OR = 1.832, 95% CI: 1.005-3.340), trigger point ischemic compression (OR = 2.999, 95% CI: 1.184-7.597) and fascial neuro-connective manipulation (OR = 3.086, 95% CI: 1.346-7.077) are more likely to experience it. In terms of lifetime prevalence, female manual therapists and those who perform trigger point ischemic compression are more likely to suffer from thumb pain (females: OR = 2.569, 95% CI: 1.339-4.930; trigger point ischemic compression: OR = 2.878, 95% CI: 1.319-6.281). CONCLUSIONS: Special attention should be paid to prevention during manual skills training, since inexperience exposes manual therapist to a higher risk of developing thumb pain.

High Pressure Injection Injury of the Thumb. Case Study.

High-pressure injection injury (HPII) is a rare severe hand trauma associated with high rates of complications and amputations of the peripheral parts of the fingers and permanent hand dysfunction. Early detection and treatment are crucial as any delay may result in a considerable functional deficit of the affected limb or amputation. The rate of amputation following HPII is 48%. This case report aims mainly to present the problem of HPII and general standards of management of such injuries. The routine use of supportive treatment in hyperbaric chambers, in the absence of contraindications, is also encouraged.

Wide-awake extensor indicis proprius to extensor pollicis longus tendon transfer.

This article provides video and narration to describe the technical details of how to inject local anesthesia and perform the extensor indicis proprius to extensor pollicis longus tendon transfer in patients with wide-awake local anesthesia and no tourniquet. Lidocaine for anesthesia and epinephrine for hemostasis are the only 2 medications given to the patient. Sedation and the tourniquet are not required. Wide-awake patients are comfortable, cooperative, and educable, and are able to help the surgeon set the correct tension for the transfer. They flex and extend the thumb before the skin is closed to make sure the transfer is not too tight or too loose. It helps that they remember seeing the thumb move nicely during the surgery when they are in postoperative hand therapy.

A painful thumb.

Isolated traumatic carpometacarpal (CMC) dislocation of the thumb is a rare injury. There are many different ways to manage a thumb CMC joint dislocation which ranges from closed reduction with or without Kirschner wires and casting to ligament reconstruction. However, it is still up for debate on the best management for this injury. We describe a case of isolated traumatic carpometacarpal dislocation of the first CMC joint in a 22-year-old student and reviewed the evidence on management. Our patient was managed with manipulation under anaesthesia (MUA). She returned to preinjury activities with no difficulties within 2 months. Good outcomes can be achieved with MUA to manage dislocation of the first CMC joint; however, those with high activity of the hand may also benefit from ligament reconstruction.

Chinese scalp acupuncture relieves pain and restores function in complex regional pain syndrome.

Complex Regional Pain Syndrome (CRPS) can result from trauma or after surgery. It is often difficult to manage effectively. If not recognized early, it can result in significant debilitation. Symptoms attributed to CRPS include neuropathic pain, allodynia, sudomotor changes, and decreased range of motion. It can occur with (Type II) or without (Type I) nerve injury. A number of soldiers sustaining extremity injuries during combat have manifested these symptoms. Two subjects were diagnosed with CRPS after sustaining upper extremity injuries during military operations. After failing conservative treatment, Chinese Scalp Acupuncture (CSA) was used once to twice a week for 1 to 4 weeks. CSA resulted in improvement in the pain visual analog scale or numeric rating scale by over 80% in two soldiers with upper extremity CRPS. Additionally, decreased sensory changes and improved function were noted on exam and therapy assessments. Notably, the pain reduction, functional improvement, and normalization of sensation have been fully maintained between treatments. The treatment response had been sustained at 20-month follow-up with no recurrence. CSA provided lasting pain reduction, and improved function and sensation in this group of combatants with upper extremity CRPS.

Aeromonas septicemia after medicinal leech use following replantation of severed digits.

Medicinal leeches are used to control venous congestion. Aeromonas in the leech gut are essential for digestion of blood. This case report describes a patient who had Aeromonas bacteremia develop after leeching. He had an injury to his hand that required replantation of his thumb. Following the surgery, leech therapy was started with ampicillin-sulbactam prophylaxis. Sepsis developed. Blood cultures were positive for Aeromonas that were resistant to ampicillin-sulbactam. The antibiotic was changed to ciprofloxacin on the basis of the sensitivity profile of the organisms. Cultures from the leech bathwater confirmed it as the source of the Aeromonas. Clinicians who use leech therapy must be aware that leeches can harbor Aeromonas species resistant to accepted prophylactic antibiotics and that sepsis may occur.

Open transtrapezial injuries of the thumb: operative treatment.

Open transtrapezium injuries of the thumb are not common and sufficiently described injuries. We have clinically and radiologically evaluated six patients with transtrapezium injury of the thumb. The average follow-up time was 65 months. All injuries occurred in young people, who had high-energy trauma to their thumb. Fracture of the trapezium with exposure of the first carpometacarpal joint was a constant along with soft tissue damage. The latter included thumb tendons, digital nerves and arteries, motor branch of the median nerve, palmar or dorsal branch of the radial artery, and thenar musculature. All trapezium fractures were fixed with mini 1.5 mm screws. All the other injured structures were repaired by microsurgical techniques. Physiotherapy protocols with emphasis to electrostimulation were used within 2 weeks postoperatively. Clinical assessment included objective and subjective criteria, which revealed moderate loss of motion because of musculature loss either by direct trauma or by denervation. No correlation was found between types of trapezium fracture and disability. Internal osteosynthesis with 1.5 mini cortical screws provided excellent stability. Despite the severity of the initial trauma the results were surprisingly good.

The prevalence of thumb problems in Australian physiotherapists is high: an observational study.

QUESTION: What is the lifetime and current prevalence of thumb problems in Australian physiotherapists and what are the factors associated with thumb problems? DESIGN: Survey of a random cross-section of physiotherapists. PARTICIPANTS: 1562(approximately 10% of the total) registered Australian physiotherapists. OUTCOME MEASURES: General questions covered demographic information, area of practice, hours worked per week, and years worked as a physiotherapist. Specific questions about thumb problems covered thumb affected, symptoms, onset of symptoms, treatment sought, relevance of work-related factors, and joint hypermobility. RESULTS: 1102 (71%) questionnaires were returned and 961 (68%) completed. The lifetime prevalence of thumb problems was 65% and the current prevalence was 41%. Factors that were significantly associated with thumb problems included: working in orthopaedic outpatients (OR 3.2, 95% CI 1.8 to 5.8); using manual therapy (OR 2.3 to 3.4, 95% CI 1.7 to 5.1), trigger point therapy (OR 2.3, 95% CI 1.7 to 3.0) and massage (OR 2.1, 95% CI 1.6 to 2.8); having thumb joint hypermobility (OR 2.2 to 2.6, 95% CI 1.4 to 4.5); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (OR 4.2, 95% CI 2.9 to 5.9). Of those respondents who reported thumb problems, 19% had changed their area of practice and 4% had left the profession as a result of their thumb problems. CONCLUSION: The prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers.