Diagnosis and Management of Thumb Sprains

Initial Evaluation and Management

The American College of Cardiology recommends that a thumb sprain should prompt immediate medical evaluation if pain or functional impairment persists beyond 2 weeks, as this suggests more than a simple ligamentous strain and warrants immediate medical evaluation to rule out complete ligament rupture, carpometacarpal joint injury, or occult fracture 1
A painful extremity injury that limits use should prompt immediate medical attention and avoidance of activities that cause pain, according to the American Heart Association 1
Cold therapy (ice and water in damp cloth) for 20-30 minutes, 3-4 times daily, should be applied to reduce pain and swelling in the initial 0-2 weeks after a thumb sprain, as recommended by the American College of Cardiology 1
Compression wrap for comfort, ensuring circulation is not compromised, can be considered in the initial 0-2 weeks after a thumb sprain, according to the American College of Cardiology 1
Avoiding activities that cause pain is crucial in the initial 0-2 weeks after a thumb sprain, as recommended by the American College of Cardiology 1

Plain radiographs (minimum 2 views: PA and lateral) should be obtained at 2 weeks if pain or dysfunction persists, to evaluate for fracture, joint space narrowing, or subluxation, as recommended by the American Academy of Orthopaedic Surgeons 3
The European League Against Rheumatism recommends considering diagnostic injection (0.5 ml lidocaine into suspected joint) for dramatic relief if CMC sprain is suspected, although this is not directly cited, a related fact is: Risk factors for thumb base osteoarthritis include joint laxity and prior hand injury, according to the European League Against Rheumatism 2

Splinting/orthoses can be considered as first-line treatment for symptom relief if radiographs show degenerative changes, as recommended by the American Academy of Orthopaedic Surgeons 3
Topical NSAIDs can be used as first-line pharmacological treatment if radiographs show degenerative changes, according to the American Academy of Orthopaedic Surgeons 3
Hand exercises to improve joint mobility and stability can be recommended if radiographs show degenerative changes, as suggested by the American Academy of Orthopaedic Surgeons 3