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Hyperextension of the thumb can be treated in different ways, depending on the true nature and severity of the injury. If the hyperextension injury was mild, and caused no fracture, dislocation, strain, sprain, tendon/muscle rupture, or swelling, then the injury may be treated with initial icing and a release to regular activities. Unfortunately, this is rarely the case.

I like to rule out the bad stuff first. I will usually x-ray the thumb to ensure that there is no fracture. If a fracture is present, then the thumb will need to be splinted or casted for up to 6 weeks, pain control with Tylenol or a mild opiate will be necessary, and the patient will likely need some eventual occupational therapy to regain any lost range of motion. If no fracture is present, I go to step 2 (below)...

I will then test all the joints of the thumb to check for dislocations. If there is laxity (looseness) in a joint, I will either splint that joint for 2-4 weeks and then initiate occupational therapy, or I will sometimes refer for an MRI to check for severity of the associated ligament disruption. Surgery is sometimes necessary. If no dislocation is present, I move to step 3...

I check the passive range of motion at each joint of the thumb to further ensure that there are no problems with the joints. I check the active range of motion to ensure that there are no problems with the nerves, muscles, or tendons of the thumb. Problems with muscles, tendons, or joints will probably require splinting for a number of days or weeks, ibuprofen, ice, and eventual possible occupational therapy. If this is all okay, I move to step 4...

I will check the muscle strength at each part of the thumb to make sure that none of the tendons that run the thumb are disrupted. If they are, it is possibly a surgical case. If they are not, I go to step 5...

Finally, I check the sensation and circulation in the thumb, to further ensure that no disruption of the nerves or blood vessels of the thumb has occurred. If there is one, it may be a surgical case. If not, then conservative management with ibuprofen, ice, and possibly a light splint for a 2-7 days should be sufficient.

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Q: How do you treat a hyperextended thumb?
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