Why does my thumb hurt?

There are many potential causes for thumb pain, but the three most common conditions that tend to develop are 1) arthritis, 2) trigger thumb, and 3) de Quervain tenosynovitis. The location of the pain and symptoms can help determine the exact cause of your pain and what your best treatment option may be.

Thumb arthritis as seen on x-ray.

1) Thumb Arthritis

Thumb arthritis is more common with advancing age, and causes pain at the base of the thumb where it meets the wrist. This can cause discomfort with everyday activities that use the thumb, such as getting dressed, writing, opening jars, or pinching and grasping objects. Swelling can be present, and the joint can be very sensitive to the touch. Weakness is also common, and patients may complain of dropping items.

An x-ray can be helpful for diagnosis. The severity of the arthritis and exact location can help with treatment recommendations.

The most common treatments include anti-inflammatories (topical or pills), a brace, or a cortisone injection into the arthritic joint. In severe cases, surgery can be very helpful to treat the arthritic joint.

A commonly used splint for thumb arthritis.

2) Trigger Thumb

Trigger thumb is another common cause of thumb discomfort. It causes pain along the palm side of the thumb, along with a clicking, catching, or a popping sensation when bending and straightening the thumb. Occasionally a painful nodule can be felt.

Common treatments include splinting or a cortisone injection to shrink the swollen and inflamed tendon. Surgery is usually not necessary, but when all else fails, releasing the band of tissue (A1 pulley) that is clasping the tendon and preventing it from gliding smoothly provides a very reliable and effective cure.

Trigger thumb is caused by swelling of the tendon that bends the finger. The abnormal nodule in the tendon prevents the tendon from gliding smoothly, resulting in clicking, catching, or locking when bending the thumb.

3. De Quervain Tendonitis

De Quervain tendonitis causes pain along the thumb side of the wrist, which is worse when moving the thumb, or when pressure is applied to the area. It is caused by swelling of the tendons that extend the thumb, which prevents them from gliding smoothly through their sheath. Swelling is often seen along the wrist, and occasionally a popping or catching sensation can be present along the wrist. It is common in new mothers, after trauma to the wrist, or with overuse (such as cell phones!). Oftentimes it just develops “out of the blue”.

Cortisone injections are extremely effective, and are oftentimes combined with a wrist brace to limit thumb and wrist motion. If the swollen tendons can not be shrunk with rest and anti-inflammatories, occasionally the sheath will be released to allow the tendons to glide smoothly.

De Quervain tendonitis is caused by swelling of the tendons that extend the thumb. This prevents them from smoothly gliding through their tunnel (top image).

If the swelling does not improve with conservative treatment, the roof of the tunnel can be released to allow for smooth and comfortable tendon gliding (bottom image).

Skier’s Thumb

A “skier’s thumb” is an injury to the ulnar collateral ligament of the thumb. This ligament is an important attachment between the thumb proximal phalanx and metacarpal bones. Sometimes this ligament sprains or tears following a fall onto the thumb. If the thumb is bent backwards or forced to the side (such as when falling with a ski pole in one’s hand), the ulnar collateral ligament may abruptly tear. However, sometimes the ligament slowly stretches out and fails over time, this injury is then referred to as a “gamekeeper’s thumb”.

Thumb anatomy.png

A thumb with a torn ulnar collateral ligament will be painful, oftentimes swollen, feels week, and is difficult to bend normally. The pain tends to be worse when pinching or grasping items, such as a holding a coffee cup, a doorknob or a pencil.

The severity of a thumb sprain can usually be determined by an orthopaedic or hand physician, who will test the stability of the injured thumb compared to your uninjured or normal side. X-rays can be helpful to assess for fractures, and in some cases an MRI may be obtained to visualize the ligament.

Low-grade thumb sprains will usually heal in a brace. Normal ligament healing typically takes around ~6-8 weeks. A thumb spica splint or brace is usually worn full time for 4 weeks, then part time (such as for activities, lifting, or when sleeping) for another 4 weeks.

High-grade tears, or more complete ligament injuries, especially those resulting in the thumb being unstable, may be treated surgically. The torn ligament is sutured back in place. Approximately 90% of the time the ligament is torn from the proximal phalanx, and 10% of the time from the metacarpal bone. A suture anchor is typically used to hold the suture and ligament back to the bone. This is an outpatient procedure, done through a ~1 inch incision, which takes ~30 minutes. Afterwards, a splint is worn full time for ~4 weeks and part-time for another ~4 weeks. Typically normal motion is restored, and pain is eliminated.

A suture anchor is placed into the proximal phalanx. The attached sutures allow for the torn ligament to be stitched back down to the the bone. Image from AO Foundation.

If a skier’s thumb, or ligament tear is not diagnosed or treated, the pain and weakness continues to be present, and can oftentimes result in arthritis.

Read more about thumb sprains here.

Dr. Schreiber in the news- E-scooter injuries are on the rise

Dr. Schreiber in the news- E-scooter injuries are on the rise

As an orthopaedic surgeon in Raleigh, North Carolina specializing in hand and wrist conditions, I have seen several injuries from electric scooters in my practice over the past year.  Many of these injuries involve broken bones of the hand or wrist.  When traveling at 15 miles per hour, sometimes the injuries are significant. 

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is an injury to the tendons along the outer elbow. The inflammation from this injury can cause pain, weakness, aching and tightness. The muscles that open the fingers and extend the wrist all combine to form a common tendon along the outside of the elbow. In tennis elbow, inflammation or tearing of this tendon causes pain with use of the hand and arm.

"Can using a computer cause carpal tunnel syndrome?"

Many patients will ask the question: “Did I develop carpal tunnel syndrome from too much time spent using a computer or keyboard?” The answer to this question is typically: “Maybe”. For most individuals, the cause of carpal tunnel syndrome is unknown. However, there are several risk factors that have been identified, one of which is computer work.

“My tingling hands wake me up at night!”

One of the most common reasons for which a patient will come see me in my office is due to a tingling sensation in their hands. This oftentimes happens at night when sleeping, and can severely disrupt the quality of their sleep. These patients oftentimes say that a burning sensation, or pain in their hands wakes them up throughout the night, and they either need to 1) shake the hand, 2) hang it off the side of the bed, or 3) raise the hand up in the air to alleviate the symptoms.

"I broke my wrist, now what?"

A fall onto an outstretched hand can result in several different injuries to that arm.  Among the most common injuries is a broken wrist.  There are several different fractures that can occur throughout the wrist, the most common is a break at the end of the radius bone.  This is often referred to as a “distal radius fracture”.  This is the most commonly broken bone in the body, with over 600,000 breaks in the United States per year.  The injury is commonly seen both in kids and adults.

Pain on the back of your wrist? – It may be “Dorsal Wrist Impingement Syndrome”

It's not uncommon that I see a patient who complains of pain along the back side of the wrist, which is worse (and usually only present) when the wrist is fully extended (or bent backwards).  These individuals feel a pinching discomfort in the wrist while doing activities such as yoga, pushups, or simply lifting themselves from a chair.

Dr. Schreiber selected winner of the "Outstanding Paper" award at the 2017 American Association of Hand Surgery Annual Meeting in Hawaii

The American Association for Hand Surgery (AAHS) had their 2017 annual meeting last week in Waikoloa, Hawaii.  A research study that I have been working on with colleagues at Stanford University was presented, and was fortunate enough to have been selected as the winner of the meeting’s “Outstanding Paper” award. The goal of the study was to try and find an easy way for hand surgeons to diagnose osteoporosis in their office.  

Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.