Charles V. Toman, MD - 4/18/2009

Question
This is something that you have surely heard of before:

1. I was in a fight with a guy, and I punched him-- hard;
2. I'm a weightlifter, and can handle 110# dumbbells, and so the force was enough to knock the guy unconscious for a few seconds.
3. The second day afterward I went lifting and heard a loud pop. It seems that my thumb joint had come dislocated (as the X ray showed).
4. When I went to the doctor, he was able to move the joint in and out of position with great ease.
5. Strangely enough, a couple of days later the swelling had all gone down. There is some very light discomfort.

During the doctor visit, he told me that I had to have something called a "Joint reduction" and that there was just no other way around it. Not a cast, or general rest or anything else other than being cut on.

What are the questions?

1. What can you tell about the severity of my case from my description?
2. Do joints in situations like this spontaneously heal, or is that rare/ impossible/ "Unlikely"(=physician talk)?
3. What happens during a joint reduction surgery?
4. I like to lift a lot of very heavy weights. How long after a surgery is it safe to do this? Can the joint bear significantly less weight than what it did before (I don't do over 315# on the bench press-- and I dislocated the joint only putting up 245#).
5. Any other things that you can tell me about this would be greatly appreciated.

Nota Bene: I am in Mainland China, and there are some language barriers that make it difficult. And there is the other issue that Chinese people are notorious liars and that the doctor who saw me more than likely told me whatever was necessary for me to pay him for a surgery (which he says is one hour-- and keep in mind that the first doctor that I went to offered to do the same surgery for 4x the price and keep me in the hospital for NINE days for what was very likely an outpatient surgery).

Answer
Lemas,

First of all, sorry you hurt your thumb.  As for your questions...
1. It is obviously hard for me to evaluate you over the internet.  It sound like you may have subluxated or dislocated a joint in your thumb but this is not a very common condition.  It is more common in the other fingers.  If the X-ray showed a dislocation then it is likely that it was in fact dislocated.  I don't know which joint, but if it was at the base of the thumb it is either the MCPJ or the basilar joint.  The MCPJ is the 2nd joint down from the nail.  If it was this one, you could have injured the collateral ligaments or the volar plate, a thick ligament on the underside of the thumb.

2. it is possible for these injuries to heal on their own in some/most instances, but there are certain variants that require surgery.

3.  During a joint reduction surgery ( i would call it an open reduction) An incision is made, and the joint is put back in the proper position.. the injured ligamentous structures are repaired and this may require a pin to be inserted to protect the repair.  Some people do not pin, but this is based on the stability of the joint after the procedure.  You will likely be placed in a cast or splint after surgery.

4.Time before lifting is hard to say.  If everything goes well, the soft tissues that were repaired should be healed by 6-8 weeks. You will then have to rehab your thumb in order to get your motion and then strength back.  

5. There is no way this surgery should be anything other than an outpatient procedure and it should take less than an hour, but could take an hour.

Good luck with this.  Let me know if you have any other questions or if you would like me to elaborate more on one of the points above.