What happened to two-year old's thumb?

April 9, 2008 8:02 AM

Two-year old caught his thumb in a door. After two hours, the child no longer complained of pain, was using thumb fine. No swelling, cuts, or outward signs of trauma. However, the thumb "clicks" and locks in a straight position if the child extends his thumb. Is this a permanent injury? What damage was sustained? What should we ask the doctor when we visit?

I realize he needs to send a doctor. Believe me when I say it has taken over nine hours total before we could even find out which doctors are covered by our "platinum" insurance plan.

More details: The child is 2 years old. He stopped crying very soon after the injury, and was back to using his thumb and playing, so we did not go to the emergency room. He does not seem to be in any pain if we move the thumb, bend the joint etc.

The child can bend the thumb on his own, but it clicks out of the straight locked position. By clicking, I mean that you feel the bones locking up if you hold his hand. There is a very slight auditory click.

The injury occurred last night. This morning, there is still no swelling, no complaint of pain from the child, however when he woke up, he didn't have the strength to bend the thumb out of the locked straight position. After we bent it down for him, he was able to straighten it and bend it on his own, however, it still locks up. Again, the child is not exhibiting any signs of pain whatsoever. If he showed even the slightest pain, we would be in the emergency room.

What is this injury? What is causing the clicking and the locking up? I assume if a bone or ligament was damaged, the pain would be excruciating and there would be swelling. And help or insight would be appreciated.

posted by Pastabagel to health (10 comments total)

Do you know if his thumb always did that? Is this the first time your really paying attention to it ? Maybe, its just how his thumb works. Mine clicks in a similar way.
posted by Rubbstone at 8:13 AM on April 9

I can't tell you about the injury, but I question your reasoning for waiting to find a doctor instead of taking your child to the Emergency Room? The next time you child suffers, what you believe may cause permanent injury, I would suggest taking your child to the hospital. The doctors there are just as well trained (if not better - they see MANY different symptoms and issues, every day.) and can provide immediate assistance, depending on the severity.
posted by dnthomps at 8:13 AM on April 9

I jammed my middle finger about ten years ago with a basketball (catch FAIL!). It still clicks nowadays, but there's no pain or anything, and it doesn't affect me at all on a day-to-day basis.

I would work to find a pediatrician within your plan and just go to him every time you need some help. It's also good to have someone that you can just call and ask about these things, without having to set up an appointment.

I don't think a finger-caught-in-door would be an emergency room event, personally. If the kid looks and acts better in a short period of time, I would also have dismissed it as just a kid-injury that will get better on its own. Kids get into lots of little accidents, many of which do not merit hospitalization.
posted by that girl at 8:33 AM on April 9 [1 favorite]

Sounds like trigger thumb.
posted by amro at 8:37 AM on April 9

I did something similar when I was a kid -- jammed my thumb hard. It was stiff and nearly unusable for a couple days afterwards, and will occasionally still get stuck in an extended position, strong enough that I need to use my other hand to pop it back into movement. (This is...maybe 18 years later? Maybe a little more?) I never saw a doctor about it. So...if he's not in pain and the joint is usable, he'll likely be fine. YMMV, of course.
posted by kalimac at 8:39 AM on April 9

Your child should have a primary care physician by age two.
posted by 1 at 11:28 AM on April 9 [mark as best answer]

He does. One that can't seem him until tomorrow. Hence the search for someone else.

Then find someone smart to help you figure out why you didn't go to an emergency room as soon as the accident happened.
posted by JimN2TAW at 11:24 AM on April 9

I guess that leaves you out. First, I didn't find out about the injury until hours later - when there was no no pain and no swelling. And have you ever been to a major metropolitan emergency room at night? The bleeding, beaten, heart attacks, OD's, generally dying and unconscious take precedence over kids who are laughing.

On preview, thanks, amro. The site you link also mentions "Often a palpable nodule, or bump, is felt at the base of the thumb in the palm" which I did also notice.
posted by Pastabagel at 8:47 AM on April 9

You're right, and I apologize. I automatically leap to the defense of children in all cases. I skipped past the part where you said: I realize he needs to send a doctor. and I went straight to your following sentence which implied that the child didn't even have a doctor (which you have since corrected). And you have added that the child will see the PCP tomorrow. Sorry for the distraction.
posted by JimN2TAW at 9:14 AM on April 9 [1 favorite]

My 2yo has also had his fingers caught in door hinges (twice). The first time we went to the closest ER and were there about 5 hours. Not fun for anybody. But we later got some of the best advice ever: go to the closest ER that has a ER pediatrician. The next time we ended up in the ER, we were seen much faster (within 40 min) and all for driving a few extra blocks in another direction. I would also call his PCP no matter what the hour (or hours after the injury if you're still wondering about what to do) and they can often smooth the way for you at an ER or even meet you there if they think it's worth it.

As for the injury itself, in both cases my kid got x-rays to ensure there weren't any fractures. Kids bones are still a bit soft, but they grow so quickly at this age that the doctors wanted to rule out any fractures that would get worse and present more problems with rapid growth.
posted by cocoagirl at 12:54 PM on April 9

No idea if this is applicable, but the clicking noise might be diagnostic.
The body has a meniscus in 8 places, two per knee, one on each side of the jaw, and one at the base of each thumb. The clicking noise can be characteristic of a cracked meniscus. (Ever notice those people who roll their lower jaw until it makes a cracking noise? Blown meniscus. Also, I think if one of them goes, the rest of them tend to be weak, which might be something you'd want to be aware of.)
You're going anyway, just mention it when you get there. If that's what it is, I don't think it would have mattered if you found it yesterday or tomorrow. You could ask the doctor that, if it would make you feel better.
cocoagirl has a point, if the growing plate of the bone is broken, it might cause the bone to stop growing, so they might want to Xray it.
That said, I occasionally have a thumb lock up, but mine are just a muscle spasm and not important, so it could be something harmless. You're doing the right thing, you're going to show it to someone; just try not to worry in the meantime.
IANAD. Just smashed a thumb a few times as a kid.
posted by unrepentanthippie at 7:21 PM on April 9

Thanks, everyone for your answers, especially for the tip about finding an ER with an ER pediatrician. And no worries, JimN2TAW.

Turns out amro was right. According to the orthopedist, the clicking trigger thumb after an injury, but not accompanied by bleeding, cruising, or noticeable swelling, means that the tendon itself became every so slightly inflamed. Because of the inflammation, it is slightly too thick for the grooves in the bones ("pulleys") in which that tendon slides. So that's what was causing the tightness and the locking. The doctor said it would go away on its own in a few days, and in fact it is already noticeably improved since I posted the question.

Thanks for everyone's concern.
posted by Pastabagel at 7:14 AM on April 11