The thumb is the most important and most utilized digit of the hand. It is pivotal through a range of activities from power gripping a dumbbell to the fine manipulation required to thread a needle. It is a complex structure, consisting of four bones and three joints, controlled by 8 muscles and numerous nerves.
Thumb pain can come from many different structures or tissues around the thumb, and can be referred from the wrist, forearm, or even the neck.
The most common causes of thumb pain we see in our busy practice are arthritis (inflammation of the joints), tendonitis (inflammation of the tendons), neuritis (inflammation of the nerves), and trauma.
Arthritis may be of many types; the most common is osteoarthritis also known as ‘wear and tear’ arthritis. Early treatment of thumb arthritis may include medications, splinting, hand therapy, modification of activities, and steroid injections. If all these measures fail, surgery can minimize pain and restore thumb function.
Repetitive activities using the thumb can lead to tendonitis. Tendonitis, if recognized early, can be treated successfully with immobilization (rest), medication (anti-inflammatories), and sometimes hand therapy and steroid injection. Tendonitis involving the tendon that flexes the thumb can lead to triggering (snapping of the thumb). If conservative measures do not alleviate the problem, surgical release of the affected tendon is sometimes required.
Neuritis and compression of the nerves to the thumb can occur at any point from the neck to the thumb tip. The most commonly recognized sites are at the wrist, forearm, and neck. The symptoms due to nerve irritation can be variable and include pain, numbness, tingling, weakness, cramping, muscle wasting, or any combination of the above. The location, degree of compression, and the possible presence of nerve damage dictate the treatment approach your doctor will prescribe.
Trauma to the thumb can be sustained by an injury as minor as bumping it against a table, to an incident as severe as a fall while skiing or an industrial accident. The injuries range from broken bones, tendon and ligament ruptures, to cut nerves and arteries. The treatment necessary is best provided by a qualified physician who specializes in care of the hand and upper extremity.