Thumb plays a major function in human organic structure. It initiates 50 % of manus map as a whole. The pollex is alone from other fingers in both anatomically every bit good as bio-mechanically. ( Ashkenaze, et Al, 1992 ) Anatomically, thumb consists of a metacarpal and two phalanges ; in the distal row of carpal castanetss, trapezium with this bone. ( Donald, 2008 ) . The thumb gives opposition to the other fingers and thenar whilst making grasping and preciseness. Thumb is working like a mechanical constituent dynamic ligament and strong musculuss ( Imaeda.T, et Al, 1992 ) . `` The trapeziometacarpal articulation is potentially the most unstable but has adapted to its alone place by particular joint geometry and, in peculiar, a combination of support ligaments that permit a broad scope of gesture yet stableness '' ( Imaeda.T, et Al, 1992,
The metacarpophalangeal articulation has six-degree freedom of motion, extension and flexin, adduction and abduction, supination and pronation. The scope of motion in thumb metacarpophalangeal articulation is non standard for everyone, the fluctuation is depends on the radius of curvature of the metacarpal caput.
Incidence of hurt additions, when there is a restriction in scope of gesture within the articulations. The intrinsic stableness is minimum in metacarpophalangeal articulation ; proper and accessary indirect ligament renders the sidelong support. The beginning of proper indirect ligament is from the sidelong condyles of metacarpal, which lies sidelong and infix on the palmar facet of proximal phalanx. This ligament is tight during flexure and relaxes during extension. The accessary collateral originates from cervix of metacarpal and inserted into the palmar home base and sesamoid bone. This ligament is tight during extension and relaxes during flexure ( Donald, 2008 ) .
The articulation of carpometacarpal articulation is between trapezium and base of metacarpal. It is saddle assortment of articulation, which interlocked in return with perpendicular longitudinal axis ( Donald, 2008 ) .
Abduction and adduction, this motion occurs in the concave plane of carpometacarpal articulation. The metacarpal axial rotations and semivowels in opposite way during abduction and adduction of carpometacarpal articulation ( perpendicular to handle ) .
Flexure and extension, this motion occurs in bulging plane of carpometacarpal articulation. The metacarpal axial rotations and semivowels in same way during flexure and extension of carpometacarpal articulation. ( Norkin, et Al, 1992 )
The anterior volar and posterior oblique ligament, the front tooth and posterior intermetacarpal ligament and dorsal radial ligament provide the ligamentous stableness for trapeziometacarpal articulation. The beginning of anterior ( palmar ) oblique is from trapezium and inserted into palmar portion of the pollex metacarpal. This is the premier ligament for stableness of carpometacarpal articulation. The dorsal ligament is reenforcing by anterior posterior ligament because dorsal ligament is non effectual as palmar ligament ( Donald, 2008 ) .
Common INJURIES IN THUMB FOR RUGBY PLAYERS
Thumb Metacarpal Fracture:
Metacarpal caput of thumb break is uncommon, indirect to mobility of CMC articulation of pollex. Mechanism of hurt is direct injury. Shaft break of pollex metacarpal is besides uncommon, indirect to mobility of CMC articulation, due to the presence of strong cortical bone of pollex. High energy is required to fall in the shaft of pollex metacarpal than shaft of metacarpal of other finger. Shortening and mal rotary motion leads to fracture of this bone, which happens due to slackness of intermetacarpal ligament and due to altered force of the intrinsic musculuss.
Fracture base of pollex metacarpal is common in rugger. Mechanism of hurt is due to the axial burden on partly flexed shaft of metacarpal. The mobility of the CMC is important, minor to the anatomy of trapezium and base of metacarpal. Two sorts of saddle articulations are topographic point in propinquity whose axis is perpendicular to each other ( Donald.R.L, 2008 ) . 'Ligamentous stableness at the trapeziometacarpal articulation is maintained by the front tooth ( palmar ) and posterior oblique ligaments, anterior and posterior intermetacarpal ligaments, and the dorsal radial ligament ' ( Donald, 2008, p-5 ) .
Fracture of metacarpal base differentiated into intra articular and excess articular. The intra is articular divided into Bennett 's break and Rolando 's break. Fractures in excess articular portion of metacarpal base are common. The breaks most likely occur in oblique or in cross manner, which takes topographic point proximal to metaphyseal-diaphyseal junction. Due to the drawing force of adductor pollicis and flexor pollicis brevis and kidnapper pollicis brevis ; the distal fragment adducted and flexed ( Donald.R.L, 2008 ) .
Bennett 's Fracture
Fracture disruption of first metacarpal with subluxation and carpo metacarpal articular surface break. This break disruption is common in rugger participants. Bennett 's break is an intra articular break with subluxation, the subluxation is due to the withdrawal of deep ulnar ligament which is the strong stabilizer for carpo metacarpal articulation. During break, the break segments reposition the joint surface. This in bend causes disruption hence it known as break disruption. The mechanism of hurt is direct blow on partly flexed pollex whilst the participant tries to undertake an opposition. Failure to handle can take to disablement through hold in pinching, bitching and resistance motion of pollex. ( Priano SV, Baratz ME, 2008 )
Rolando 's Fracture:
It is same as Bennett 's break with comminuted break at the base of first metacarpal. It is besides called three portion break. There will be in Y or T shaped intra articular break at base of metacarpal. The three shred break parts are base of dorsal metacarpal, bovine spongiform encephalitis of palmar metacarpal and shaft of metacarpal. This break is non common but the forecast is worst than Bennett 's break. Mechanism of hurt is increased axial tenseness to the partly flexed pollex, which burst and interrupt the articular surface of first metacarpal. ( Priano, Baratz, 2008 )
Fracture of thumb phalanges:
The pollex has two phalanges ; distal and proximal phalanx. The most common site of break in pollex phalanges is shaft and caput. The break of distal phalanx divided into intra articular and excess articular break. The excess articular bunch break, normally accompanied with soft tissue hurts like loss of soft tissue, hurt to nail bed and posttraumatic neuromas. Mechanism of hurt is due to direct blow or direct hit. Intra articular break is due to avulsion hurt of the sinew. There are two types of intra articular breaks viz. , mallet break and New Jersey break. Avulsion of extensor sinew is mallet break and flexor digitorum profundus is jersey break. Proximal phalanx breaks are common in phalangeal caput and shaft. ( Laub, Priano, 2008 ) .
Ulnar indirect hurt
The ulnar indirect ligament of metacarpophalangeal articulation injured due to the forceful abduction of metacarpophalangeal articulation. There will be partial or full tear of the ligament associated with avulsion break of palmar base of proximal phalanx. ( Leggit, Meko 2006 ) . In uncomplete rupture, proper ulnar collateral ligament ruptures but the accessary ulnar collateral ligament still integral. In complete rupture, there will be complete rupture of both the proper collateral ligament and accessary indirect ligament. The ulnar indirect ligament normally ruptures from the interpolation of the distal portion, over the proximal phalanx base ( Donald, 2008 ) .
When, the distal portion lies superficial and proximal to adductor apponeurosis. This fluctuation called as a Stener lesion. The discrepancy does non mend due to the interjection of the adductor aponeurosis between distal and proximal ligament terminals ( Donald, 2008 ) .
'Gamekeepers suffered chronic hurt due to contorting the cervixs of game between their pollex and index finger ' ( Foye, et al 2007 ) . Hence, it besides called game warden 's pollex. It is besides common in athleticss people who play with ball ( rugger, baseball ) . Presence of swelling and contusing on the joint with the thumb hyper extended and deviated laterally. Painful over the ulnar portion of MCP articulation associated with decreased ability of appreciation and pinching ( Foye PM, Raanan J, Stitik TP, 2007 ) . After the exclusion of break, estimate the ligament stabilisation by giving antagonistic force per unit area to one side and using abduction force per unit area to the other side of UCL. Evaluate with uninjured manus ( Donald, 2008 ) .
Avulsion of the extensor sinew causes the pollex to be fixed in partial flexure with the presence of cadaverous fragment. This avulsion occurs due to the high impact flexure of the interphalangeal articulation. Tendon break will be present in unfastened mallet pollex caused by laceration ( Leggit, Meko, 2006 ) . Closed mallet thumb hurt is non common. The mechanism of closed mallet hurt is indirect to an acute forceful flexure of IP articulation of the pollex ( Donald, 2008 ) .
Dislocation of interphalangeal articulation of pollex
The primary motion of interphalangeal articulation is flexure and extension, because interphalangeal joint maps as flexible joint articulation. Interphalangeal joint stableness to ulnar and radial force maintained by collateral and accessary indirect ligament associated with the trochlear form of the joint. A thick hempen gristle known as palmar home base supports the palmar facet of the joint. The palmar home base at interphalangeal articulation has a individual sesamoid in it ; which increase the mechanical advantage of flexor pollicis longus. Freedom in flexure and extension of interphalageal articulation is render by a flexible capsule present dorsally and volarly. The disruption of interphalangeal is uncommon. It occurs largely in dorsal. The mechanism of hurt is hyperextension with rotary motion ( Glickel et al, 2005 ) . The disruption is hard to cut down due to the ruptured palmar home base caparison ( Leggit, Meko, 2006 ) .
Dislocation of Metacarpal phalange articulation of pollex
Palmar disruption is less common than dorsal disruption. Palmar disruption normally accompanied by the rupture of indirect ligament with hurt to sesamoid bone. The ability to cut down is more palmar than dorsal disruption. The mechanism of hurt in dorsal disruption is hyperextension of metacarpophalangeal articulation, secondary to the autumn on stretched manus over the floor or direct impact over the thumb tip. In the disruption to the dorsal, normally there will be rupturing of palmar home base at proximal and motion at distal. The disruption is irreducible due interjection of palmar home base within the joint ( Glickel et al, 2005 ) .
MECHANISM OF THUMB INJURY IN RUGBY
To develop preventative programs, it is of import to hold a good apprehension of the mechanism of hurt ( Gibbs, 1994 ) . The considerable scope of organic structure contact and hit between the participants were the ground behind the hurts in rugger ( Pringle, et Al, 1998 ) . Most of the hurts occur due to physical hit ; hence, bar of hurts is non possible to certain grade. The chief mechanism of most hurts is due to undertaking, which is the of import portion of rugger lucifer. Researches had done to the per centum of hurts in undertaking ; the per centum scope from 38.2 % ( Gabbett, 2003 ) and 77.2 % ( Nortan, et Al, 1995 ) . 'Results are assorted sing the facet of the tackle doing hurt, with some writers happening more hurts happening to the participant tackled and others to the participant being tackled ' ( Hoskins, et Al, 2006, p 49 ) .
The playing season have been affected by weariness hurts and repeated micro-trauma, which has an accumulative consequence. The certification of increasing hurt ratio states that as the patterned advance of season, the hurt degree additions, largely in the 2nd half of the season at non-professional ( Gabbett, 2000 ) and semi-professional degree ( Gabbett, 2003 and 04 ) . 'Gabbett put this correlativity down to an addition in match strength towards finals. It could besides be the consequence or participants transporting hurts that have non to the full resolved ' ( Hoskins, et Al, 2006, p 52 )
In thumb most of the hurts occur during the lucifer than in preparation period. Thumb break may happen due to the forceful backward bending. Fracture of phalanges of pollex may happen when pluging a solid object or catching a ball, when the ball forces the thumb backward. During undertaking the opposition participant may nail the pollex by chance. There may be complete or partial tear of the ligaments that stabilizes the pollex articulation ( The doctor and athleticss medical specialty, 1997 ) .
TREATMENT FOR THUMB INJURIES
Soft TISSUE INJURIES
In soft tissue hurts, immobilisation of thumb articulation is appropriate for partial tear. Splints and patchs used for the immobilisation of the joint. Immobilizations maintained until the hurt heals. After three hebdomads of immobilisation, take the splints for making exercisings like flexure and extension with the aid of pollex. Set back the splints after the exercising, for the protection. Repeat this undertaking for two to three hebdomads, until the swelling and tenderness reduces to certain scope. Apply ice over the hurt for two to three yearss after the hurt.
In complete tear, surgery is the appropriate intervention. Avulsion break may happen during complete tear. After surgery, immobilisation done with short-arm dramatis personae or splint to protect the pollex, for six to eight hebdomads ( Sports scientific discipline orthopedic clinic, 2009 ) .
Rehabilitation for soft tissue hurt of pollex
Proper rehabilitation is highly of import for soft tissue hurt. Because for a rugger participant, the one and merely focal point is acquiring back to full strength every bit shortly as possible ; So that they can return to developing and competition.
Rest - Rest is most of import in the acute stage of hurt. Do non put to death an activity that causes hurting.
Ice - Application of ice or cold battalion will cut down the redness. Apply over the pollex for 15 to 20 proceedingss ; go on this for 4 times a twenty-four hours.
Medication - Take anodynes to cut down hurting and redness.
Compression- Compressing the pollex with elastic compaction patch helps in cut downing the puffiness and stabilizes the pollex.
Stretching - Gentle stretching should get down after the acute stage. Perform stretching in hurting free scope. Keep the stretch for 10 seconds with six repeats ( Sports scientific discipline orthopedic clinic, 2009 ) .
FRACTURES OF THUMB
Pre infirmary attention
Application of ice to the injured portion will cut down redness. Splinting may avoid motions whilst going to infirmary. The break will go unstable and hard to handle if there is hold in intervention. Prior to the definite intervention the pollex should splinted with tablet to avoid farther harm to the fractured bone.
Emergency section attention
Thumb breaks are intervened by surgeries. The specializers like manus or orthopedic sawbones make the determination for surgery. The boney alliance will restored by several operative arrested development techniques done by the manus sawbones. This arrested development holds the bone in topographic point until they heal. The internal arrested developments usually used for thumb break are wire, pins, home bases and prison guards. Another method called external arrested development, where the pins in the bone comes out of the tegument and attached to an external arrested development device. The pollex would immobilise with pollex Spica splint for all hurts in pollex ( American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand, 2003 ) .
Well-molded functional brace ( glove type or short arm pollex Spica ) have applied for 4 to 6 hebdomads ( Demirel, 2006 ) .
Rehabilitation for thumb break
Outpatient therapy is required for the participants who have sustained break. Duration of intervention depends upon the location, type of break and continuance of immobilisation. The rehabilitation must be furnished depends upon the stableness of the break and direction of the break, whether it is operative or non-operative. The grade of disablement will be act uponing by the forbearance 's manus laterality and involved appendage. Restoring full scope of gesture and independency in day-to-day activities with strength will be the premier focal point of rehabilitation ( Hriticko, 1998 ) .
To diminish the hurting and restore map is the primary end of rehabilitation. Ice therapy and cold battalions may be utile in cut downing the hurting. If the dominant pollex had been involved, particular attention would given to reconstruct the map of uninvolved fingers. After the remotion of plaster dramatis personae, the healer will get down scope of gesture exercising and strengthening exercising for the fractured pollex. A particular attending should give to intrinsic and extrinsic musculuss of manus ( Feehan, 2004 ) . Full scope of gesture should stress on the injured pollex. Progression in exercising should accomplish after the full map attained
( Krop, 2002 ) .
REHABILITATION EXERCISE FOR THUMB
The recovery and possibilities of re-injury is depends upon the restitution and increasing original scope of gesture of the injured pollex articulation. In rugger and in other athleticss and many athleticss activities expose the pollex to injury. Re-injury is uncommon if one time the pollex was injured. This exercising is utile to forestall the hurts in both the pollex ( Sports scientific discipline orthopaedic clinic, 2009 ) .
This exercising would execute in sitting place on chair. The cubitus of the injured side placed over the thigh of the same side. Flex the cubitus at right-angled and fingers are extended. The index of opposite manus should hold on the injured pollex. Draw back the injured pollex gently. The motion would be in pain free scope, halt the motion if hurting exists. Maintain the stretch for 10 seconds and give remainder for 10 seconds. Repeat this exercising for five proceedingss, thrice a twenty-four hours. Notice the patterned advance in scope of motion in each twenty-four hours, the injured pollex draws back a spot farther ( Sports scientific discipline orthopedic clinic, 2009 ) .
This exercising would execute in sitting place on chair. The cubitus of the injured side placed over the thigh of the same side. Flex the cubitus at right-angled and fingers are extended. Flex the injured pollex inward, touch the base of small finger of the same manus with the tip of the injured pollex. Make this activity in hurting free scope. Keep the place for 10 seconds and loosen up it for 5 seconds. Repeat this activity for 10 times for thrice a twenty-four hours. Progressions in the scope of motion would noticeable in each twenty-four hours. The pollex of injured pollex will touch the base of small finger of the same side ( Sports scientific discipline orthopaedic clinic, 2009 ) .
This exercising would execute in sitting place on chair. The cubitus of the injured side placed over the thigh of the same side. The cubitus is flexed right-angled hold oning ball in the manus. Keep the ball in thenar of the manus and attempt to squash it with the aid of pollex and fingers. Maintain the squeeze for 10 seconds and loosen up the pollex for 5 seconds. Repeat the sequence for 10 times, thrice a twenty-four hours ( Sports scientific discipline orthopaedic clinic, 2009 ) .
When the rehabilitation exercisings are contraindicated n ague phase, this alternate exercisings may be used. This alternate exercisings, does non necessitate any motion in the injured pollex, which aggravates the hurting in the injured pollex. The alternate exercisings are swimming, jogging, stationary bike ( Sports scientific discipline orthopaedic clinic, 2009 ) .
Prevention OF THUMB INJURIES IN RUGBY
Thumb hurts in rugger are hard to forestall due to the contact and aggressive manner of the athletics. Many hurts are acute and traumatic in nature. The lone manner to forestall thumb hurts by guaranting correct warm up, cool down, beef uping and flexibleness plans ( Sports hurt clinic, 2009 ) .
Warm up exercisings
Warm up plays a major function in the bar of hurts. Warm will besides assist in bettering the public presentation in the athleticss. The advantages of warming up are:
Additions musculus temperature.
Additions blood supply and O supply to the musculuss.
Increases the scope of motions in the articulation of pollex, therefore cut down the hazard of musculus and ligament tear ( Sports hurt clinic, 2009 ) .
Warm up should incorporate:
There should be increase in pulse scope for 10 proceedingss to increase the blood and O supply to the musculuss. This can accomplish by making active and inactive motions of the pollex. The motions like flexure, extension and abduction, adduction and rotary motion of the pollex articulation have to execute.
Proper stretching technique ensures increase in the scope of motion in the pollex articulation ( Sports hurt clinic, 2009 ) .
Cool down exercisings
Cool down is resting or puting down. It can assist in cut downing the hazard of hurt and increase the public presentation. The advantage of chilling down is:
Decrease the bosom rate bit by bit.
Restore the blood supply and O supply to the musculuss to the phase were in before exercising.
Wash out the waste merchandises in the musculuss like lactic acid.
Decrease in the hazard of musculus tenderness ( Sports hurt clinic, 2009 ) ..
Regular athleticss massage favours in washout the waste merchandises like lactic acid from musculuss and tight knots, balls in the musculuss can let go of. Hence, if untreated causes strain and tear to the musculuss of pollex ( Sports hurt clinic, 2009 ) .
A assortment of protective equipment and vesture are available specific to the athletics of rugger. Many companies are involved in the design and production of protective equipments. Even though there are many advantages of the equipment, contention still exits ( Gerrard, 1998 ) .
Straping and taping
Leuko strap- Strapping plays a major function in back uping the articulations during the unsmooth athleticss activities. It even provides compaction, support and rational control to stabilise the injured articulation and ligaments of pollex. It restricts the joint scope of gestures beyond its scope. In which, hurt would be prevented in thumb articulation ( Gerrard, 1998 ) .
Long drama support- Wraps gives uninterrupted support to the joint through out the drama. It is made of elastic and cross nylon fibers. It gives excess strength and controlled compaction to the articulations ( Gerrard, 1998 ) .
Protect the recent hurt.
Braces can non model to suit a peculiar articulation than a tape is able to cover ( Gerrard, 1998 ) .
A trained individual should use taping
Apply tape after the professional probe.
Avoid tapping in hapless blood circulation.
Check for allergic reactions in skin prior to tapping.
Straping should execute in clean and dry country.
Avoid strapping over unfastened lesion ( Gerrard, 1998 ) .
Long drama support braces- it keeps the pollex joint warm and keep proper circulation. It minimizes the opportunity of hurt and prevents supplanting of articulations. Support brace provides stableness to the pollex articulation.
It is inexpensive and less clip devouring to use.
Support the ligament and articulation of the pollex.
Players feel comfy to have on ( Albright, et al,1995 ) .