Living With Chronic Pain

Thumbs Down to Thumb Pain

As humans we have a huge advantage due to our opposable thumb. They allow us incredible dexterity and manipulation over our environment. Because of this our poor thumbs are often improperly and over used in all sorts of activities throughout the day. It’s no wonder most of us suffer from some degree of thumb pain, after using devices for hours at a time, lifting heavy items, trying to grip or open something, writing and so much more. Because of the constant wear and tear it endures it’s the second most common type of hand arthritis.

Pain in the thumb can be caused by a number of underlying medical reasons – from mechanical to anatomical to infection to trauma. Defining the etiology will depend on any inciting events, when, how often, where, and the type of pain felt. In fact, according to some studies, we have nearly a 40% lifetime risk of suffering from arthritis in the hand, just one possible cause of thumb pain.

Here are the most likely culprits:

Arthritis

Cartilage covers the ends of all bones, acting as a cushion and allowing them to glide smoothly when in motion. When arthritis occurs, the cartilage deteriorates and the ends become rough. The resulting friction allows the bones to rub against each other, often producing abnormal bone growth e.g. spurs that leads to further pain and impairment. The joint where the thumb joins the wrist is the most common place for this to occur. Most start over 40 and worsen with age. There’s a higher incidence in women but I wonder if this is due to the constant impact our purses have on the thumb every time we throw them on onto shoulders. Think about it. All that weight for one brief moment falls directly onto an outstretched, vulnerable thumb.

It can be due to- Osteoarthritis– wear and tear, aging, Rheumatoid arthritis or other autoimmune diseases such as lupus, psoriatic gout.

Symptoms


*Pain at the base of the thumb

*Redness

*Swelling

* Trouble gripping or pinching

*Loss is strength

*Loss of motion

*Joint deformities

DeQuervains tenosynovitis

This happens when the tendons that go from the wrist to the thumb are swollen or the sheath that surrounds them gets swollen and then constricts the tendons. Although the true etiology is poorly understood, women 30 -50 are more affected. It has been nicknamed “mommy’s thumb” because we tend to use our thumbs far too much when lifting babies and children and “gamers thumb” because it often arises in those who use game controls a lot. But even holding a pen, pencil, digital device or texting extensively every day can contribute. If making a fist enclosing the thumb and rotating towards your pink pinky finger hurts between the base of the thumb to the wrist- A Finkelstein test- talk to your provider and see if this diagnosis applies to your situation.

Symptoms

*Pain and stiffness at the base of the thumb and even into the wrist

*Swelling and tenderness with activity

*Decreased strength and range of motion

*May have a lump at the base of the thumb.


Strains, sprains and injuries

Anything that damages the ligaments or tendons (a sprain) or muscles (a strain) at or around the thumb can cause transient complaints. They commonly occur during sports e.g. “the skiers thumb” which occurs with falls while holding a ski pole or the thumb is jammed by a fall. Often, falls are broken with an outstretched hand and wrist putting both areas at risk. This is a common way to injure the ulnar collateral ligament (UCL). It’s vulnerable when the thumb is bent back and away from the hand. As a children it’s susceptible to injury when used to pull the thumb something. Overuse can cause temporary issues as well. Fortunately, if minor, they all tend to resolve with rest and stopping the inciting activity. See your healthcare provider if you have any concerns it’s a more serious injury such as a fracture or tendon/ligament rupture that requires immediate intervention.

Symptoms

*Swelling and stiffness

*Warm and tingling

Trigger finger

As I’ve discussed in a past post this is an extremely disconcerting issue that feels like the joint is locking in one position. It’s one of the most common causes of hand pain. There’s a 3% chance of developing a trigger finger in your lifetime but women are two to six times more likely to suffer from one. Diabetics are 10% more prone to developing a trigger finger as are those with arthritis, especially rheumatoid. The risk worsens as we age and with repetitive activities such as typing. The volume has increased in all age groups because of the devices we use daily. A finger triggers when the tendon at the base of the thumb swells, impeding movement at the joint. When it progresses a painful nodule is created which impedes the tendon from gliding through the sheath often leading to a clicking sound as it catches when the digit is moved. In severe cases it can get stuck in one position.

Symptoms

*Pain on movement

*A clicking sound when the joint is moved

* A lump at the base of the thumb, palmar side

* Triggering and locking of the digit

*Stiffness and swelling

Carpal tunnel syndrome

It starts in the wrist on the thumb side and radiates pain into the first thru fourth digits. This is caused by compression of the area in the wrist – the carpal tunnel- where the median nerve rests causing pain in its entire distribution. This nerve allows for movement and sensation in the thumb through ring fingers. Repetitive activity such as typing on a computer for hours, ringing up items in a store, hairstylists, therapists, or anyone who keeps the wrist flexed a good portion of the day. Diabetes, pregnancy, thyroid dysfunction, injury, alcoholism, autoimmune diseases such as rheumatoid arthritis are also often contributing factors. It’s important to see your healthcare provider to get an accurate diagnosis and appropriate treatment. Left untreated it can result in permanent nerve damage and persistent symptoms.

Symptoms

*Numbness and tingling- feels like pins and needles in the affected distribution

*Pain

*Trouble gripping

*Loss of strength

*Can radiate up to the forearm

Ganglionic cysts

A ganglionic cyst occurs when a balloon like lesion grows out of the tissues surrounding the joint such as tendons, their sheaths, ligaments and joint linings. It gets filled with synovial fluid that is thick and syrupy in consistency. This is the stuff that acts as a lubricant for our joints. A tender lump may be seen under the skin on the palm side that’s tender to the touch. It becomes more obvious when you extend the digit, less so when flexed. Most resolve on their own but when severe they can be injected, drained or excised. Although their cause is unknown it’s more common in people 15-40 years of age and women are more likely to be affected then men. Gymnasts are often impacted since it appears to be related to repeated stressful activity. When it occurs at the last joint in any finger (DIP – distal interphalangeal joint) it’s called a mucous cyst. These usually result from arthritis, with women age 40-70 more affected.

Symptoms

*Tender soft tissue mass

*Impede motion

*If pressuring a nerve, then tingling and muscle weakness can occur.

From driving, holding a device, writing, carrying packages, lifting, drinking, eating… our thumbs are an integral part of everything we do. We’ve all experienced pain at some point in our lives due to overuse. For others, it’s long term and debilitating. If any of your symptoms are severe, persist, or worsen, seek out professional care.

Next week I’ll discuss risk factors, diagnosis, possible preventions and treatment options.

Sources:

https://www.nhs.uk/conditions/hand-pain/thumb-pain/
https://www.healthline.com/health/thumb-pain#treatment
https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/symptoms-causes/syc-20378339
https://www.yalemedicine.org/conditions/thumb-arthritis
https://onlinelibrary.wiley.com/doi/full/10.1002/art.40097
https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-thumb/
https://orthoinfo.aaos.org/en/diseases–conditions/sprained-thumb

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