• Reference Number: HEY-256/2021
• Departments: Orthopaedics
• Last Updated: 19 January 2021

Introduction

This leaflet has been produced to give you general information about your injury.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a soft tissue injury?

The term soft tissue refers to muscles, ligaments and tendons that surround and support our joints. Injuries to the soft tissue surrounding the thumb are usually caused by a forceful stretch when landing awkwardly on the hand or direct blow for example when playing ball sports.

What are the symptoms?

A soft tissue injury to the thumb may result in:

• Pain.
• Heat, redness or bruising.
• Swelling.
• Stiffness and loss of function.

Pain relief

To manage your pain it is advised that you regularly take simple pain relief which can be brought over the counter.  If you have allergies or conditions which prevent the use of pain relieving or anti-inflammatory medication, please seek advice from your doctor or a pharmacist.

What should I do in the first 72 hours after the injury?

The most important initial treatment is aimed at controlling the pain and swelling by following the principles of RICE:

R – Rest

Complete rest is not advisable but it is important that you prevent putting the thumb under strain in the early stages of healing.  Ensure you continue to move your fingers and wrist as normal as it is common for these joints to quickly become stiff.

I – Ice

Ice will help reduce the pain in your thumb and so should be applied for 10 – 15 minutes. This will help to reduce the swelling

There are many different ways in which ice can be applied however it believed crushed ice, in the form of frozen peas for example, is the most effective. Whichever method you choose it is important that you wrap the ice in a damp towel, in order to prevent it from ‘burning’ the skin.

Please Note:

Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.
Do not apply over an open wound.
Do not apply an ice pack to an area that has poor circulation.
During ice application check the skin every five minutes and discontinue its use if:

• the area becomes white, blue or blotchy.
• the area becomes excessively painful, numb or tingles.

C – Compression

You may have been given a special compression bandage to wear to help control swelling in your thumb. It is important this is removed if you develop any signs of poor circulation such as tingling, numbness, blueness of the skin of the thumb and increasing pain. Unless otherwise advised the bandage should be removed when you go to bed at night because when you are asleep you cannot monitor these symptoms.

E – Elevation

If you have swelling in your thumb, sit on a chair and place your elbow on cushions so that it is level or slightly higher than your shoulder. In this position point your hand towards the ceiling then open and close your hand as this will further help to reduce any swelling.

What not to do

Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided. It is important to note that smoking may also delay the healing process.

Rehabilitation and recovery

If you follow this basic advice your injury should take around six weeks to heal. However, everyone recovers from injuries at different rates and it is dependent on the severity of the injury and the presence of any other medical problems. It is possible you may suffer symptoms for up to three months.

After 72 hours it is very important you try to start using your hand normally again especially when doing everyday tasks like washing, dressing and eating. The exercises below will help you to regain full function, flexibility and strength.

1. Hold your thumb with your other hand so that all you can move is the end joint.

Bend the end joint of your thumb as far as you can and feel it stretching. Hold this for 10 seconds. Now straighten this joint as if you were doing the thumbs up motion. Hold this for 10 seconds.

2. Touch your thumb to the tip of the index finger on the same hand.

Now slide your thumb down this finger as far as possible until you feel it stretching. Hold 10 seconds. Repeat the same exercise as described above while touching your thumb to your middle finger, then your ring finger and finally your little finger. Each time hold the stretch 10 seconds.

3. Hold your hand upright palm facing away from you

Move your thumb sideways away from your palm as far as you can and feel it stretching gently Hold this for 10 seconds.

4. Next point your hand forward as shown in the picture.

Try to take your thumb out as wide as you can and feel it stretching gently. Hold the stretch for 10 seconds.

5. Lastly put your hand flat on the table palm downwards

Lift your thumb upwards so that it lifts off the table. Hold for 10 seconds and relax.

All photos with kind permission of ©Physiotec™

You should try to practice the exercises 10 times each, 4 times per day. You may experience more discomfort when you start exercising however this is normal and does not mean you should stop.  If your symptoms remain worse for more than two hours after the exercises then you should decrease the number of each exercise that you do and build up again slowly.

When can I return to normal activities?

If your job involves activities using your hand and thumb regularly you must ensure that you practice similar tasks so that you build your strength and function up gradually.

If you participate in an active hobby then it is advised that you do not return to this until you have full range of movement, strength and you can use your hand normally without experiencing pain or swelling.

If you play a sport involving use of your hand and thumb, practice sports specific activities like gripping a tennis racquet or a cricket bat to prepare yourself. Build this up gradually before returning to full training sessions and competition.

Do I require further treatment?

You may be advised that you require physiotherapy following this type of injury, unless your symptoms are minimal on your initial appointment. Your physiotherapy could be at a variety of locations in the Hull and East Riding area.

You can self-refer to physiotherapy by contacting the following number depending on the location of your doctor:

• Hull GP patients self-refer to Healthshare: (01482) 300003
• East Riding GP patients self-refer to East Riding Physiodirect: (01377) 208300 or self-refer online at chcpmsk.org.uk

On occasions the clinician may wish to refer you to the physiotherapy team within the hospital trust. If this is the case they will advise you of this and you should receive an appointment at Hull Royal or Castle Hill Hospitals within 5 to 7 days of your attendance at the Emergency Department. If you have received no contact within this time please call the physiotherapy admin team on (01482) 674880.

When to seek further help

If 10 days following your injury you are unable to use the thumb and it remains painful and swollen, despite following the above advice, please contact the physiotherapy team that you were advised to contact at your Emergency Care attendance.