My partner got in a fight at the bar last night. Now he has a swollen, painful thumb (right at the base of the thumb). We are doing ice to it and he's taking aspirin. Is there anything else to watch for?
You may want to get an X-ray to make sure the thumb or wrist isn't broken. Fist fights are notorious for causing fractures of the thumb, wrist, or hand. Keeping the hand still (not using the muscles) is advised until an X-ray can rule out (or rule in) a fracture.
If there is a broken bone, immobilization is essential. Fractured bones can become displaced (separated) when muscles and tendons pull on the fracture site where the tendons attach. That turns a simple fracture into a more complex one.
The orthopedic surgeon will probably take several X-ray views in order to get a close look at the trapeziometacarpal (TMC) joint. That's a common area injured in fist fights. There's a particular type of fracture called a Rolando fracture that affects this area. It's a Y-shaped break that can cause misalignment of the joint surface.
Treatment beyond rest, ice, compression, and elevation (R.I.C.E.) may be needed. A cast or ever surgery may be necessary. Get in to see a doctor soon in order to know for sure and prevent unnecessary long-term complications.
Ignacio Proubasta, MD, PhD, et al. Rolando Fractures. In Current Orthopaedic Practice. November/December 2010. Vol. 21. No. 6. Pp. 615-623.
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