Dr Child's Casebook: A Sense of Disconnect

A feeling that something’s ‘out of place’ is a painful one when you are hypermobile or live with a connective tissue disorder.  Muscles attached to flexible, overly supple joints must work much harder than most and this can lead to strain and fatigue. And it can be a real pain in the joint when these overstretched junctures in the body become abnormally separated, as they are wont to do in Marfan syndrome. Sensing something was partially ‘out of place’ at a critical point in her hand – currently an overused 'tool' for picking up her child - a member of our community called our helpline seeking respite. 

Q: I wondered if your wider audience and Dr Child has any advice for possible dislocations?

I have been in pain with my thumb for almost 2 weeks. It feels like it’s out of place (at the base close to the wrist) but it’s definitely not fully dislocated because I would otherwise be in agony? I’ve tried ice/cold treatment and I’ve tried bathing it in hot water in the sink. Has anybody else experienced this sort of part ‘out of place’ feeling?

I have previously required wrist surgery (trimming jobs via keyhole) so I’m aware this area of mine maybe weak. Unfortunately, I can’t really rest it which understandably must be adding to the prolonged pain. I work full time and have 3 children, one is a toddler and unfortunately does require lifting. I do my utmost to go down to their level and sit on the floor etc but toddlers being toddlers there’s nothing more they like than to claw at my legs shouting ‘up, mummy, up’. This lifting ‘need’ forms a short period of their life and I’ll have to persevere for now. Does anyone have tips on manipulating the joint back into position I wondered or soaking in some wonder drug?

A: You probably have a subluxed Joint - this means that it slips partially out of place, and can go back in with manipulation.

A ‘subluxation’ is basically defined as “a partial dislocation”. It can be no less painful than a full dislocation but the two bones that form the joint are still partially in contact with each other.

A dislocation is defined as “displacement of a bone from its natural position in the joint”. This is where the two bones that form a joint fully separate from each other.

The main reason this is a phenomenon amongst those with Marfan syndrome is fibrillin which is an important component of connective tissue, providing stretchy strength in ligaments, tendons and in joint capsules which act like a tennis ball, surrounding and holding the bones in the joint together. In Marfan syndrome, the fibrillin is defective and so joint support is lost, making dislocations more likely to happen.

However, although yours is most probably a subluxed, not dislocated, joint, it may well need surgery ultimately to position it, and fix it in its proper position. This will make it strong enough to be used carefully for necessary tasks like lifting baby.

Please ask for referral to an orthopaedic surgeon specialising in hand and wrist. Also, as a temporary measure, you could be referred to an orthotics department for a splint or brace for your thumb, to wear when working. However, this joint will not get better, as it is continuously under stress. It will probably need corrective surgery, so do pursue both approaches at the same time.

You will be very pleased once this common problem is corrected permanently. Meanwhile your little one will learn to climb up on to the sofa beside you for hugs.

Dr Child's Casebook: A Sense of Disconnect
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