Joe A Shaw PA-C - 6/24/2008

Question
I dislocated the IP joint of my thumb, which caused severe deformation and swelling. In the ER, the doctor took x-rays and tried to put it back into place, but it would not stay. He referred me to an orthopedic doctor that pinned the joint without even doing an MRI. He removed the pin after 4 weeks and I had very little movement and a lot of pain in the joint. It has been 3 months since the pin was removed and I still have some tenderness and little movement. The joint is unstable in one direction to a point that I can slightly bend it sideways, which tells me that the ligament did not heal. I did three weeks of physical therapy with no improvement. Is it still possible to repair the damage after 4 month since the dislocation occurred? I am not going back to this doctor, because I don't think that he did it right the first time. I work allot with my hands and I need this thumb.

Answer
Jerry,
IP thumb dislocations are fairly uncommon, they usually dislocate dorsally (i.e. not palm side) It would not be necessary to get an MRI of the thumb for this (I never heard of it anyway). The surgeon can expose the area easily anyway and get direct visualization of the area, which is better than an MRI anyway. You might have had an injury or fracture to the plate or sesamoid bone area of the thumb joint for him to use a pin. Yes you may have torn the collateral lig. and it can be repaired if needed. This injury  will take about 12 mos before you can say it's about as good as its going to get. I would encourage you to see the same ortho again, b/c he knows the case the best etc..but that is your call