The thumb plays an essential role in hand function, participating in about 50% of all hand movements. This highlights just how crucial our thumbs are for everyday tasks, from the simplest to the most complex. When thumb pain strikes, it can significantly impact your ability to perform daily activities, making you realize just how much you rely on this digit. Understanding why your thumb hurts is the first step towards finding relief. Several conditions can lead to thumb pain, and this article will explore some of the most common culprits, including trigger thumb, arthritis, tendonitis, carpal tunnel syndrome, and skier’s thumb.
Trigger Thumb
Trigger thumb, also known as stenosing tenosynovitis, occurs when the tendon that bends your thumb, called the flexor pollicis longus (FPL), becomes irritated and inflamed. This inflammation hinders the tendon’s smooth gliding motion through the sheath that surrounds it in the thumb. Imagine a rope running through a tunnel; if the rope swells, it will have difficulty moving freely.
Sometimes, the tendon develops a nodule or swelling that catches on the pulleys, which are ring-like structures that guide the tendon. This catching can cause your thumb to click, snap, or even lock in a bent position, often suddenly popping straight with a painful snap – hence the name “trigger thumb.” Besides the triggering sensation, you might experience swelling, stiffness, and significant pain in your thumb, particularly at the base of the thumb or in the palm at the base of the thumb.
Treatment for trigger thumb aims to reduce inflammation and restore smooth tendon movement. Initially, conservative treatments are usually recommended. These include:
- Rest: Avoiding activities that aggravate your thumb can help reduce inflammation.
- Anti-inflammatory medications: Over-the-counter pain relievers like ibuprofen or naproxen can help manage pain and reduce swelling.
- Splinting: Wearing a splint can keep your thumb in a straight position, resting the tendon and preventing nighttime curling that can worsen symptoms.
- Steroid injections: A corticosteroid injection into the tendon sheath can effectively reduce inflammation and provide longer-term relief.
For many individuals, these non-surgical treatments are enough to resolve trigger thumb. However, if symptoms persist despite these measures, trigger thumb release surgery may be considered. This procedure is generally very effective and involves a small incision to release the constricted portion of the tendon sheath, allowing the tendon to glide freely again.
Thumb Arthritis
Thumb arthritis, specifically osteoarthritis of the carpometacarpal (CMC) joint, is another frequent cause of thumb pain, especially in older adults. The CMC joint is located at the base of your thumb, where your thumb meets your wrist. This unique joint is what allows the thumb its remarkable range of motion, including opposition – the ability to touch your thumb to your fingertips, which is crucial for countless daily tasks.
Over time, the cartilage that cushions the bones within the CMC joint can wear down. This wear and tear, often due to normal aging and repetitive use, leads to osteoarthritis. As the cartilage deteriorates, the bones rub directly against each other, causing pain, inflammation, stiffness, and eventually, decreased range of motion and weakness.
While osteoarthritis is a common part of aging and currently not preventable, its symptoms can be effectively managed. Treatment strategies focus on reducing pain and inflammation and improving joint function. These can include:
- Topical anti-inflammatory gels: Creams or gels applied directly to the skin over the CMC joint can deliver pain relief.
- Oral over-the-counter medications: Pain relievers like acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs) can help manage pain and inflammation.
- Activity modification: Adjusting how you use your hand and thumb to avoid aggravating activities can reduce stress on the CMC joint.
- Thumb splints: Supportive splints can stabilize the CMC joint, reduce pain, and improve hand function. These are particularly helpful during activities that cause pain.
- Steroid injections: Corticosteroid injections into the CMC joint can provide significant, though temporary, pain relief and reduce inflammation.
Similar to trigger thumb, most people with thumb CMC arthritis find relief with non-surgical treatments. However, if pain and functional limitations persist despite these efforts, surgical options are available. Thumb CMC joint surgery can effectively reduce pain and improve quality of life in more severe cases.
De Quervain’s Tendonitis
De Quervain’s tendonitis (or tenosynovitis) is a condition affecting tendons on the thumb side of your wrist. Specifically, it involves the tendons that extend and abduct (move away from the palm) your thumb. These tendons, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), pass through a narrow tunnel or sheath on the wrist.
Repetitive hand or wrist motions, especially those involving thumb use and twisting, can cause friction and irritation to these tendons as they glide through the sheath. This friction leads to inflammation and thickening of the tendons and the sheath, resulting in pain on the thumb side of the wrist, often radiating into the thumb or forearm. De Quervain’s is commonly seen in new mothers, sometimes referred to as “mommy’s thumb” due to the repetitive lifting and holding of infants.
Treatment for De Quervain’s tendonitis aims to reduce inflammation and allow the tendons to glide smoothly again. Common treatment approaches include:
- Splinting: A splint that immobilizes the thumb and wrist can reduce tendon movement and promote healing.
- Anti-inflammatory medications: Over-the-counter or prescription NSAIDs can help reduce pain and inflammation.
- Therapy: Physical or occupational therapy can teach you exercises to stretch and strengthen the wrist and thumb, as well as advise on activity modification to prevent recurrence.
- Steroid injections: Corticosteroid injections into the tendon sheath are often very effective in reducing inflammation and providing pain relief.
While most cases of De Quervain’s tendonitis improve with conservative treatment, surgery may be recommended in some instances. De Quervain’s release surgery involves releasing the sheath around the tendons, creating more space and allowing them to move freely, relieving pain and restoring function.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition caused by compression of the median nerve as it passes through the carpal tunnel in your wrist. The carpal tunnel is a narrow passageway on the palm side of your wrist formed by bones and ligaments. The median nerve provides sensation to your thumb, index, middle, and part of your ring finger.
When the tissues within the carpal tunnel, such as tendons, swell and thicken, they can compress the median nerve. This nerve compression leads to a variety of symptoms in the hand and fingers, including numbness, tingling, and pain. While carpal tunnel syndrome affects multiple fingers, thumb pain is a common symptom. People often describe the sensation as pins and needles, burning, or even electric shocks radiating into the thumb and other affected fingers. Symptoms are often worse at night and may be aggravated by certain hand positions or activities. In severe cases, carpal tunnel syndrome can lead to weakness and even atrophy (wasting away) of the thumb muscles at the base of the thumb (thenar eminence).
Treatment for carpal tunnel syndrome aims to relieve pressure on the median nerve. Initial treatment options are typically non-surgical and include:
- Wrist brace: Wearing a wrist brace, especially at night, keeps the wrist in a neutral position, reducing pressure in the carpal tunnel.
- Stretching exercises: Specific exercises can help improve nerve gliding and reduce symptoms.
- Hand therapy: Occupational or physical therapists can provide guidance on exercises, activity modification, and ergonomic adjustments.
- Steroid injections: Corticosteroid injections into the carpal tunnel can reduce inflammation and provide temporary symptom relief.
If non-operative treatments are not successful in relieving symptoms, or if nerve compression is severe, carpal tunnel release surgery may be recommended. This surgery involves cutting the ligament that forms the roof of the carpal tunnel, relieving pressure on the median nerve and alleviating symptoms. Carpal tunnel surgery is generally very effective.
Skier’s Thumb
Skier’s thumb refers to an injury to the ulnar collateral ligament (UCL) of the thumb. This ligament is located on the inside of your thumb at the metacarpophalangeal (MCP) joint, the joint at the base of your thumb where it connects to your hand. The UCL is crucial for stabilizing the thumb, particularly during pinching and gripping activities.
Skier’s thumb commonly occurs due to a fall onto an outstretched hand, a frequent occurrence in skiing accidents, hence the name. When you fall and land on your hand, the thumb can be forcefully bent backward and away from the hand, stressing and potentially tearing the UCL. However, this injury can happen in any situation involving trauma to the thumb, not just skiing.
Symptoms of skier’s thumb include pain, swelling, bruising, and weakness at the base of the thumb. Pinch strength is often significantly reduced, and it may be painful or unstable to grip objects.
Treatment for skier’s thumb depends on the severity of the ligament injury.
- Minor sprains: For mild sprains, immobilization in a splint or cast for several weeks is usually sufficient to allow the UCL to heal.
- Complete tears: If the UCL is completely torn, surgery is often recommended to repair the ligament and restore thumb stability, especially in active individuals.
Following immobilization or surgery, hand therapy is often an important part of the recovery process to regain range of motion, strength, and function in the thumb and hand.
If you are experiencing persistent thumb pain or have suffered an injury to your hand or thumb, it is essential to seek professional medical advice. Consulting a hand specialist can ensure you receive an accurate diagnosis and an appropriate treatment plan tailored to your specific condition. Early diagnosis and treatment can help alleviate pain, restore function, and get you back to using your thumb comfortably and effectively.
