Carpometacarpal thumb osteoarthritis Also known as
basal joint arthritis, carpometacarpal thumb OA is a degenerative condition of the thumb that causes pain, stiffness, and weakness. Risk factors include repetitive hand use, female, middle aged, and previous injury to the thumb. Diagnosis is confirmed with x-ray imaging. Conservative management for this condition includes thumb immobilization, activity modification, physical therapy, and anti-inflammatories. Temporary spica splints are used to immobilize the thumb and reduce pain, especially during activities that require extensive use of the hand. Studies have shown improvement in pain scores with long-term thumb spica use (greater than three months).
Soft-tissue injuries De quervain's tenosynovitis This syndrome happens as a result of injury to the first dorsal compartment of the hand due to overuse or repetitive movements of the thumb. This injury presents as pain and swelling over the first dorsal compartment as well as a positive
Finkelstein's test. Conservative management consists of immobilization, rest, and anti-inflammatories. Temporary thumb immobilization prevents overuse of the first dorsal compartment musculature as the inflammation resolves. Several studies have noted the effectiveness of temporary thumb spica splinting in conjunction with glucocorticoid injections and non-steroidal anti-inflammatories.
Fractures Scaphoid Accounting for up to 89% of all carpal fractures,
scaphoid fractures are one of the most common injuries of the wrist. This injury usually results from a fall onto an outstretched hand and presents as pain over the anatomic snuffbox. Scaphoid fractures may not be evident on initial x-ray imaging, therefore CT or repeat x-ray images within 10-14 days of injury is suggested. Temporary immobilization with a thumb spica splint is the main treatment, even if the fracture is not initially evident on radiographs. Immobilization of the thumb reduces fracture movement as the bone heals. If the fracture is displaced and requires surgical fixation, temporary spica splinting may also be utilized to provide comfort and prevent further fracture movement.
1st Metacarpal Although there are many different patterns of 1st metacarpal fractures, these injuries are usually the result of axial loading of a partially flexed thumb. Inadequate reduction and immobilization of these fractures can result in early-onset osteoarthritis, thereby making immobilization via spica splinting a critical part of management. Diagnosis is achieved through plain radiographs. Nondisplaced or minimally displaced fractures are amendable to spica splinting for 3-6 weeks with follow-up radiographs. == Complications ==