Thumb ligaments

[DuncanM]

Many years ago (20?!) I sprained my thumbs (separate incidents playing American Football), damaging the ulnar collateral ligaments (when I went to the doctor he said something along the lines of "there's a medical term for this thumb - fucked"). I was able to continue playing, by means of taping up the thumbs each game/practice. I re-hurt the left one a few years ago playing 5-a-side, had physio and it slowly got better.

Last weekend I rode a muddy, technical cyclocross race (and crashed a couple of times). Since then, my thumbs have been really sore (the left one especially). I typically ride on the hoods, unless I need extra braking/stability, in which case I ride on he drops.

I suspect that if I were to go to the GP, their advice is likely to be "use Voltarol gel, don't ride your bike (or tape it up if you must), maybe physio". Anyone know if there are any other treatment options, or if I can improve things by changing the bike setup (only had it a few weeks, not wedded to this setup, though would hope that any changes would lead to fewer crashes!)? I'm hoping to race on Sunday the 6th, after which I have a month of no 'cross.

Currently, the bike looks like this:
2019-09-29_09-37-55 by duncancmartin, on Flickr

[chrisbainbridge]

the questions are:

• Do you want a permanent treatment?
• Do the thumbs generally hurt between cyclocross races?
• How severe is the pain?

If you damaged your ulnar collateral ligaments that badly many years ago you almost certainly have some degree of arthritis.  There is no treatment to give you a normal thumb.
If you have arthritis then ligament reconstruction is too late.  Even if you do not have frank arthritis I would hesitate to reconstruct a longterm stretched ligament as the joint motion is no longer normal.

A permanent treatment would be joint fusion which is a really good, slam dunk type operation for thumb MCP arthritis

If they do not hurt between cyclocross races then see a therapist and get better strapping, possibly a small brace to wear under gloves for racing.

If the pain is not too bad then use voltarol gel before and after the race.  You cannot do more damage so enjoy what you are doing

[DuncanM]

Normally they only hurt if I do something to open up the joint. They were fine in summer 'cross, but I probably didn't put as much shock through the bars in those races. However, on previous occasions, once they are in this state, they take some time to go back to non-painful, and functionality is a little compromised (I couldn't open a tight jar right now) but most things are doable if painful.

In general use it's dull pain, if I'm trying to do something like ride a bike then it's a little worse (even on the trainer this morning I couldn't hold the hoods in my normal way). Trying to open a jar would be very painful.
The permanent fix seems a little drastic - if I haven't done anything to them then there's no problem. However, if I'm causing damage to the joint in the process of ending up in this state, it sounds like it's something I should explore for long term health.

Short term, it sounds like I should just tape it up and see the physio. Thanks for the advice.  (ouch! )

[hellymedic]

chrisbainbridge is the expert, i'm the pragmatist.
Strap it up as needed.
Get a strap wrench like a mini Boa Constrictor for opening jars.

In general I suggest working quite hard to avoid provoking pain. This keeps ME pain-free and helps prevent further damage wherever. It also minimises use of drugs and surgery.

[chrisbainbridge]

It is a bit like a car. Once the car is knackered and too expensive to fix then just run it into the ground.

In the same way once arthrodesis /fusion is the only option then just keep using the thumb. One day the pain may get worse or it may not but you cannot damage it further to the point where no treatment is possible.

[DuncanM]

It is a bit like a car. Once the car is knackered and too expensive to fix then just run it into the ground.

In the same way once arthrodesis /fusion is the only option then just keep using the thumb. One day the pain may get worse or it may not but you cannot damage it further to the point where no treatment is possible.

While that isn't how I want to think about my thumb, it is oddly reassuring! Thanks for your input on this.

Strap it up as needed.
Get a strap wrench like a mini Boa Constrictor for opening jars.
In general I suggest working quite hard to avoid provoking pain. This keeps ME pain-free and helps prevent further damage wherever. It also minimises use of drugs and surgery.

Sounds like a plan. Thanks.

[mrcharly-YHT]

Chris is the expert.

My take on surgical repair/fusion/artificial joints is this:
The 'natural' joint is going to be better, right up until it fails utterly. Fusing is fusing and you lose a lot. Artificial joints wear out and involve removal, permanent removal, of a lot of stabilising ligaments. You don't get 6-million-dollar-man substitutes.
Stick with the original product for as long as possible. Then go for the fantastic, amazing modern replacement for your clapped out bits.

[chrisbainbridge]

 Charley is pretty much correct. However there is currently no replacement for this joint.