Funct onal Thu an

ProcedureRichard G. Deivert, PhD, ATC

T he hand is man's prime tool. Itis remarkably well designed toprovide sensibility, mobility,

and strength sufficient for an almostinfinite number of tasks.5 The joints,though designed for stability and mo-bility, remain vulnerable to extremesof external force often experienced inathletics. Protecting an injuredthumb while permitting the range ofmotion demands of sports is verychallenging for the athletic trainer.

Rigid splints are impractical andsometimes dangerous in athleticcompetition and neoprene spicasprovide only generic support. Tradi-tional checkrein and spica taping pro-cedures are not as effective becausethey limit function of the hand.The following procedure was de-

veloped to provide support to the lig-amentous structure of the thumbwithout interfering with necessaryfunction. The keys to this proce-dure's success are that very littletape is applied on the palmar surfaceof the hand, no tape spans the widthof the hand, minimal tape crosses thewrist joint, and a variation of the con-ventional thumb spica is used. Thistechnique is effective in protectingthe metacarpophalangeal (MP) jointwhile maintaining a full range of mo-tion that can be used in sports wherefreedom of movement and protectionare essential.

Supplies1. Soap and water2. Razor

3. Tape adherent4. One roll of 1-1/2" athletic tape5. One roll of 1/2" athletic tape

Preparing the Area1. Clean the hand and wrist with

soap and water.2. Shave the wrist and dorsal surface

of the thumb.3. Apply adherent to the wrist and

palmar surface of the thumb overthe thenar eminence up to the in-terphalangeal (IP) joint.

4. Allow time for the adherent to dryand become tacky.

Steps in Taping Procedure1. Apply a continuous anchor strip

to the wrist using 1-1/2' tape.2. Apply an anchor strip just distal to

the IP joint of thumb using 1/2"tape, leaving the fingernail andfingertip exposed. Anchoring dis-tally provides additional leveragewithout covering the tactile sur-face of the thumb (Fig 1).

3. Shake the athlete's hand, posi-tioning the hand in a functionalposition necessary for most sportsand activities (Fig 2).

4. Apply two to three splint stripsalong the thenar eminence using1/2" tape, overlapping by half (Fig

Fig 2.-Placing hand in functional po-sition.

3). A modification of this step in-volves applying the strips to thelateral and/or dorsal surfaces tomeet the demands of a particularsport. A 1-inch strip of moleskinor a turf toe strap may be used ifadditional support is desired.

5. Apply an anchor strip just distal tothe IP joint of the thumb using 1/2"tape, leaving the fingernail andfingertip exposed (Fig 3).

6. Prepare two "V" strips of tape.Begin with two 12- to 14-inch-longpieces of 1-1/2" tape and make a 1"incomplete tear in the middle ofeach. This piece is called a "V"strip because the tear creates a"V" in the tape (Fig 4).

7. Apply the first "V" strip, bisect-ing the webbing between thethumb and index finger, stabiliz-ing the MP joint (Figs 5 and 6).

8. The second "V" strip should beplaced slightly higher once again,overlapping by half (Fig 7).

9. Apply a close off strip of 1-1/2"tape encapsulating the top of thethumb running distal to proximal(Fig 8).

Richard G. Deivert is Director of The Lip-scomb Clinic Foundation for Researchand Education at Saint Thomas MedicalPlaza, 10th Floor, 4230 Harding Road, inNashville, TN 37205.

Fig 1.-Anchor at wrist and distal toIP joint of thumb.

Fig 3.-Application of splint stripsand distal anchor leaving fingernailand fingertip exposed.

Journal of Athletic Training 357

Fig 4.-Appearance of "V"' strip be- Fig 7.-Application of second "V"fore application. strip, overlapping by half.

Fig 10.-Palmar view of completedtaping procedure.

Fig 5.-Application of first "V" strip.

Fig 6.-Dorsal appearance of "V"strip before application.

10. Finally, close-off the wrist, an-

choring the "V" strips with1-1/2" tape (Figs 9 and 10).

Some athletic trainers may preferusing elastic tape to perform contin-uous closing distal to proximal, re-

placing steps 9 and 10. It is easier todisassemble this procedure in re-

verse than to attempt to cut about thethumb with bandage scissors or a

tape cutter. Athletes can easily learnto disassemble it as well.

DiscussionInjuries to the hand and fingers are

quite common in athletic activi-ties.2'6'7 The phalanges, particularlythe thumb, are prone to sprains

Fig 8.-Close-off strip encapsulatingtop of thumb.

Fig 9.-Close-off and anchoring of

"V. strips at wrist.

caused by a blow delivered to the topor by a violent twist. Thumb mecha-nism of injury is usually a forceful ab-duction of the proximal phalanx,which occasionally combines with hy-

1,2perextension.' Injuries to the ulnaraspect of the thumb have been esti-mated to occur about ten times more

frequently than radial injuries,7 themost common injury being the ulnarcollateral ligament sprain.1 5'10'12'13The stability of this joint is derivedfrom the ulnar collateral ligament andthe related musculotendinous inser-tion into the base of the proximal pha-lanx. This injury is frequently under-estimated because there is usually

only moderate local discomfort and nomajor deformity.

Because of its role in oppositionand gripping, an injured thumb can

easily sideline an athlete for severaldays. This injury, in most cases re-

sponding well to conservative treat-ment, occurs mostly in tackle foot-ball players, soccer goal keepers,skiers, wrestlers, and baseball play-ers. Tape protection is offered for allfuture activities that might injure thethumb again.8A few authors have described tap-

ing procedures for the fingers3 andvariations on thumb taping.49'11Other thumb taping procedures thateither increase protection or limituse11 including a checkrein, which isnot functional and somewhat dan-gerous9'11; anchoring the thumbproximally to the phalangeal joint4;or encapsulating or "pancaking"the entire hand, which greatly limitsfunction.6'9 Rigid splints inhibit nor-

mal use of the hand and thumb andare impractical for some activities.Neoprene spicas provide imprecisesupport. The technique presented inthis paper uses the broad "V" strip,providing excellent support to theMP joint without pinching, binding,or compromising comfort. Manyathletes participating in a wide vari-ety of sports have been pleased withthis functional thumb taping tech-nique.

AcknowledgmentI would like to thank Scott Gard-

ner, MS, ATC, for volunteering hisphotography skills to the technicaldevelopment of this manuscript.

358 Volume 29 * Number 4 * 1994

References1. American Society for Surgery of the Hand.

The Hand, Examination and Diagnosis. 2nded. New York, NY: Churchill Livingstone;1983:60-63.

2. Arnheim DD. Modem Principles of AthleticTraining, 7th ed. St. Louis, MO: Times Mir-ror/Mosby College Publication; 1989:807.

3. Dinkler LA. Hyperextension taping for soccergoalies. Athl Train, JNATA. 1986;21:227.

4. Doughty MP. Spica variation for the hyperex-tended thumb. Athl Train, JNATA. 1991;26:263-264.

5. Dray GJ, Eaton G. Dislocations and ligamentinjuries in digits. In: Green DP, ed. Operative

Hand Surgery, 2nd ed. New York, NY:Churchill Livingstone; 1988;1:793-811.

6. Ellsasser JC, Stein AH. Management of handinjuries in a professional football team. AthlTrain, JNATA. 1980;15:34-37.

7. Lane LB. Acute grade III ulnar collateral lig-ament ruptures. Am J Sports Med. 1991;19:234.

8. Maron BR. Orthopaedic aspects of sportsmedicine. In: Appenzeller 0, ed. Sports Med-icine-Fitness, Trauinng, Injuries. 3rd ed. Bal-timore, MD: Urban & Schwarzenberg; 1988:362.

9. McCue FC. The elbow, wrist and hand. In:Kulund D, ed. The Injured Athlete. 2nd ed.

Philadelphia, PA: JB Lippincott Co; 1988:386-388.

10. Pappas AM. Injuries of the upper extremities.In: Vinger PF, Hoerner EF, eds. Sports Inju-ries, The Unthwarted Epidemirc. Boston, MA:John Wright/PSG Inc; 1981:231.

11. Peppard A. Thumb taping. Phys Sportsmed.April 1982;10:139.

12. Smith RJ. Post-traumatic instability of themetacarpophalangeal joint of the thumb. JBone Joint Surg (AmJ. 1977;59A:14-21.

13. Tubiana R. Paralysis of the thumb. In: Tubi-ana R, ed. The Hand. Philadelphia, PA: WBSaunders; 1993;4:182-253.

Journal of Athletic Training 359

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