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Medical Author:

Justin Strittmatter, MD

Coauthor:

Charles Preston, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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The physician will first determine whether or not the patient has other limb-threatening injuries and then evaluate the thumb in more detail.

The doctor will ask the patient how the injury happened. The patient will be asked the following questions:

• At what time did the injury take place?
• What was the exact positioning of the hand and thumb during the injury?
• How soon after the injury did the pain and swelling begin?
• Did it feel as if the thumb was stressed beyond its normal range of motion?

The doctor will also ask about the patient's past medical history. The patient will be asked the following questions.

• Have you ever suffered from a similar injury before?
• Have you ever had any type of surgery in your hand or wrist?
• Are you allergic to any pain medications?
• Have you ever fractured any bones in your wrist or hand?
• Are you right-handed or left-handed?
• What is your primary occupation?

The doctor will then perform a physical examination.

• Testing the laxity (looseness) of the ulnar collateral ligament of the thumb: This test will be done by holding the base of the thumb in a fixed position, while applying a lateral (sideways) force on the tip of the thumb to see how many degrees it will move. This movement will be compared to the movement of the other, uninjured thumb. Pain may make this difficult to do immediately after the injury (in which case the injury may be treated and then reexamined in a few days).
• Assessing for normal functioning of the three major nerves in the hand
• Checking for point tenderness over certain bony spots of the hand that may indicate fracture
• X-ray of the hand to make sure no bones are broken
• Examining the rest of the arm for any associated injuries to your wrist, forearm, elbow, and shoulder

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