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Thumb Pain - DeQuervain's or Arthritis?

There are two common sources of thumb pain. The first is ARTHRITIS, a bony condition occurring in the joints. The second is a TENDINITIS or TENOSYNOVITIS, an inflammation of a thumb tendon and the surrounding sheath.

Both of these conditions are related to breakdown or micro-injury over an extended period of time – usually 35 to 55 or more years. Both are related to repetitive motion of the thumb. Both have primary pain at the base of the thumb, where the thumb meets the wrist.

Initially, these two conditions may present with similar symptoms – pain on grasping, pinching or lifting an object, turning a key, opening a jar, texting, etc. Both can eventually result in ‘resting pain’ – pain when the thumb is not being used.

Both thumb arthritis and thumb tenosynovitis are generally centered around the joint that connects the thumb to the wrist or the trapeziometacarpal joint (TMC) because it connects the trapezium in the wrist to the first metacarpal bone in the thumb, also called the CMC or Carpal-Metacarpal joint.

The construction of this joint is unlike any other. The particular shape of this saddle joint is what gives our thumbs their wide range of movement allowing the thumb to reach across the palm and contact each finger with great precision. Some feel it is this joint that is responsible for the primary developments of mankind.

This joint is involved in all thumb movements throughout life, so it receives a lot of wear and tear.

Symptoms

Symptoms of thumb arthritis and thumb tenosynovitis may appear very similar at first.

1. Pain in or around the thumb joint, particularly at the base of the thumb.
2. Swelling, tenderness and or stiffness, particularly at the base of the thumb.
3. Decreased strength when grasping, pinching or pulling
4. Decreased thumb range of motion.
5. A catching or snapping feeling when the thumb is moved.
6. With arthritis, the thumb joint may appear enlarged or mis-shapen.

Thumb Arthritis

THE ARTHRITIC PROCESS

Bones are designed so that a cushion of cartilage covers each end, where the joint articulation takes place. This allows smooth and painless movement. At the same time the cartilage protects the joint by serveing as a shock absorber.

Over time, the smooth coating may wear down and the motion becomes impaired as bone begins to contact bone instead of cartilage.

Pre-disposing factors to this arthritis are considered to be
* Being middle-aged
* Being Female
* Having a flexible, double-jointed, or ‘lax’ thumb joint
* Previous injury, fracture, or dislocation of the thumb

Frequently there is swelling or redness around the base of the thumb. It may feel warm to the touch.

Treatment is normally conservative and aimed at decreasing pain, increasing function and maintaining thumb use over the rest of your life. This is not a temporary condition. Medical consultation is highly recommended if thumb pain, swelling or movement limitation is persistent.

Thumb Tendonitis (De Quervain’s Tenosynovitis)

De Quervain’s tenosynovitis is a type of ‘tunnel syndrome’. That is, is occurs where tendons are confined to moving through a small space. It is the most common type of thumb tendinitis - by far!

Each tendon has a slippery sheath surrounding it, the synovium. The synovium aids the tendon in it’s backward and forward journey through the body by decreasing the friction between tendon and bone, tendon and sinew. When then synovium becomes inflamed it thickens and the tendons cannot move easily through the tunnel. You have Tenosynovitis. The nerve that lies on top of the tendon sheath may also be involved.

De Quervain's occurs at the base of the thumb around the saddle joint. The same joint that gives us such a wonderful opposible thumb can also create a lot of pain when we overuse it.

With De Quervain’s, pain may be at the base of the thumb when at rest, but when the thumb is moved (especially in grasping, pinching or making a fist) or rotating the hand, it is felt along the thumb side of the wrist as well and can extend up the thumb.

Almost any wrist movement may set it off as wrist motion changes the biomechanical stress on the tendon and nerve. The pain may appear suddenly or develop gradually.

Needless to say, this means pain when texting, typing, hand writing – or just about anything you use your hands to do. Numbness in the thumb and/or index finger may occur – remember that the thumb starts where is meets the wrist.

Pre-disposing factors are considered to be
* Being middle-aged
* Being Female (10 times more females than males)
* Having a recent in injury to the thumb (particularly a direct blow to the tendon)

Treatment for De Quervain’s begins conservatively, with the same general approaches used with other types of tendinitis or tenosynovitis: protection, rest, ice,compression, and elevation The goal is to relieve pain and increase function.

If treated, this condition is NOT lifelong. Early treatment will be most beneficial.If untreated, it may become chronic.If symptoms are very severe or do not respond to treatment, surgery may be recommended. Essentially, the pressure on the tendons and nerve are relieved by opening the confining tunnel to make more room.

Medical Consultation is strongly recommended if you have persistent pain (it doesn’t go away)or if the pain gets worse.

Specific treatments and precautions exists that will assist you in mitigation of pain and prevention of further injury.

If your condition requires immobilizing the thumb, there are techniques you can learn that will make your life easier while you can’t use your thumb effectively for dressing, personal hygiene, brushing your teeth, eating, etc – not to mention keying, texting…

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