I injured my thumb in late November. While using a table saw with a
dado blade, the board kicked back and I cut my thumb. Actually I cut
it in two places and I also cut the tendon, cut both bones on either
side of the middle joint, broke my thumb and broke my wrist. Following
surgery to reattach the tendon and close the wound, it was in a cast
for over five weeks. During that time the thumb became very stiff.
Both the lower thumb joint and the middle thumb joint. I managed to
get the lower joint to move, but the middle joint simply will not
bend. I started therapy about six weeks after the injury and I've now
been to 9 sessions. The middle joint still doesn't move. My doctor has
x-rayed it twice and says that the middle joint has not fused
together. I still have at least 11 more therapy sessions to go.

So here's my question. If you were in my situation what would you to
get the middle joint moving. Your answer should be based on some
medical evidence that the action at least has a chance of success.

If you want to view the injury you can go to
http://fire.prohosting.com/~summer95/MrThumbkin.html. Be advised that
this is somewhat graphic.

I understand that your answer is not medical advice. I just need to
find something that offers me some hope. I'll discuss it with my
doctor prior to acting on it.

summer95-ga:

As I am not a medical professional, I have no way of knowing whether
this will help solve your problem for you. However, based on the
personal experience of members of my family, I can suggest that you
discuss the following type of device with your doctor:

Light Force Therapy
http://www.lightforcetherapy.com/technology.cfm

The LFT devices use infrared diodes to gently relax and promote the
healing of damaged tissue and cells, helping to reduce pain and joint
swelling in arthritis sufferers. There is a chance that the therapy
may help you in your situation as well.

Regards,

aht-ga
Google Answers Researcher

Wow! You are lucky to have your thumb. In most of the world, the lack
of expertise and availability of care would mean a catastrophic
outcome.

I looked at the pictures and can easily understand why you are only
slowly regaining mobility in the DIP joint... distal interphalageal
joint. The amount of healing tissue is extensive. Healing tissue goes
through stages eventually remodeling into close to, but never
completely, normal tissue. You have extensive scarring of the skin and
the deeper soft tissue [and tendons and ligaments] as well. This
tissue has a less flexible matrix of intercellular connective tissue -
it's stiff. It is also not as strong in resisting tension [stretching]
as normal tissue.

Fortunately, scar tissue is plastic. It changes in response to the
demands put on it. You can expect that you will regain much , maybe
almost all, of the range of motion and strength over time. It will
take some patience, perseverence and therapy over more than a few
months, not just weeks.

As a  "rule of thumb"  [sorry] do UP to what hurts, not very far INTO
what hurts. As the tissue is weaker, you can over do it ... but also
"no pain... no gain".

Hope this helps.

Bill

As a plastic surgeon/hand surgeon for over 20 years, I encourage you
to keep on doing the things you are doing. Scar tissue remodels,
softens, and becomes more pliable with time. In fact it takes a full
year for stiffness such as in your thumb to improve to 80% of where it
will get by two years.

Force from your thumb tendon down at the wrist level pulling on the
distal thumb is by far the most effective action to restore motion in
the joint. It is very similar in principle to trying to "push" a chain
compared to "pulling" the chain. Tendons normally are flat,lubricated
by synovial fluid to be "slick" and have minimal friction as they
glide in movement. The injury you had heals with scar formed in many
areas, all of which are remodeling at the same time.

The function of the thumb is to oppose the other fingertips as in
picking up small things between thumbtip and index fingertip. Most of
us are right handed so the right (dominant) hand is the most likely to
be closest to the work event that causes injury. I suspect that you
are right-handed. An exercise that is universally the most helpful in
restoring motion to the fullest in finger joints utilizes limiting
motion to all joints in the affected digit except one while using the
muscle (in the forearm) that pulls, via tendon, to pull the affected
stiff distal joint in the thumb. This allows concentration of movement
and scar "stretching" to maximize return of motion in a specific
joint.

These are referred to as "Bunnell" exercises after Dr. Sterling
Bunnell, the father of hand surgery. Do the exercises for each joint
in EACH finger of your injured hand. You probably have noticed that
all of your finger joints in the injured hand seem stiffer. Part of
this is due simply to swelling throughout the hand after an injury.
Often this is exacerbated by letting the injured hand hang down. Your
Dr. moost likely had you elevate your hand to prevent this. As long as
your hand is "higher than your heart", fluid seeps out of the hand and
back toward the body. At night sleep with your injured hand elevated
on a pillow to help this.

Hot water feels good on healing, stiff tissue, but it also promotes
more swelling. That in turn relates to more stiffness so be sure to do
the Bunnell exercises immediately after if you use heat.

You had excellent care by a well trained doctor as demonstrated by
your result so far. Your web story of the injury/healing process is
excellent. I wish you the very best.

Jim Beckman, MD