Thumbs - Up !

Years of working hard and participating in your favourite hobbies can potentially take a toll on your body, especially your fingers and thumbs. Think about how much strain you likely place on your hands over your lifetime. It’s no surprise, then, that many people start to feel aches and pains in their thumbs.

Thumb pain has multiple causes, including the overuse of the thumb joint, constant repetitive actions of the joint, tendinitis, injury to the joint, osteoarthritis, carpal tunnel syndrome or rheumatoid arthritis. Such pain can also cause a loss of gripping ability.

The four most common causes of thumb pain are:

1. Thumb Arthritis

There are several types of arthritis, but the type most often affecting the joint at the thumb’s base is osteoarthritis. This is found more often in women than men and tends to occur after 40 years of age. The most prominent symptom is pain at the base of the thumb when you grasp an object or apply force with your thumb.

Signs of thumb arthritis include:

• Enlarged appearance at the joint of your thumb
• Decreased range of motion
• Decreased grasping or pinching strength
• Swelling or stiffness at your thumb’s base

Physiotherapy provides manual treatment techniques to joints and soft tissues to improve range and strengthen supporting muscles. Exercises can help to improve joint mobility, improve strength of thumb muscles, and improve function. Wax baths can aid in pain relief.

2. De Quervain’s Tendinosis

When tendons at the base of the thumb become swollen or constricted, they may cause pain along the thumb side of the wrist. De Quervain’s tendinosis may occur from overuse, but it’s also associated with pregnancy and rheumatoid disease.

Signs of De Quervain’s tendinosis include:

• Primarily pain felt over the thumb side of the wrist, along with swelling
• A snapping sensation or grating when moving the thumb
• Difficulty moving the thumb and wrist
• Pain with manual activities and weakness of grasp

Not only do hobbies and occupations provide over work for the thumb joints and tendons but many new Mums will experience aggravating symptoms from the repeated actions involved in the nursing, care and lifting of babies.( often referred to as " Mummy's Thumb") Splints are often a very important adjunct to treatment for both tendinitis and arthritis, providing unloading of the joints and tendons to reduce pain and improve stability.

3. Trigger Thumb

Trigger thumb occurs when your thumb remains stuck in a bent position, as if squeezing a trigger. This occurs when tendons become irritated and swollen and can’t move easily. Sometimes a bump may form on the tendon, adding to movement difficulty. Farmers, musicians or people in industrial occupations commonly experience trigger thumb due to the heavy reliance and strain on their fingers.

Signs of trigger thumb include:

• Snapping/popping sensation when moving the thumb
• Swelling or bump in the palm
• Inability to fully flex the thumb
• Locking in the bent position, requiring help from the other hand to straighten
• Pain and stiffness when bending
• Soreness at the base of the thumb

4. Injury- tear or sprain.

The most common name given to these injuries are

1.Skiers thumb ( acute injury) - It doesn’t have to be sking, - netball, basketball and football are common sports! Skiers thumb is a forced abduction and hyperextension of the thumb with partial or complete tear of the ulnar collateral ligament (UCL). This ligament is an important supporting and stabilizing ligament. Avulsion fractures can also occur.

2.Gamekeepers thumb ( more chronic injury) - footballers thumb these days !

Gamekeepers involves this UCL becoming stretched through repetitive stress leading to pain and instability of the joint. Both these conditions can result in disabling instability, reduced pinch strength and painful movement.

Signs of skiers Thumb.

• Fall onto hand/ wrist
• Pain at the base of the thumb in the web space between thumb and index finger.
• Swelling of your thumb.
• Inability to grasp or weakness of grasp between your thumb and index finger.
• Tenderness to the touch along the index finger side of your thumb.
• Blue or black discoloration of the skin over the thumb.
• Thumb pain that worsens with movement in any or all directions.
• Pain in the wrist (which may be referred pain from your thumb).

Most athletes are able to return to sport within 4 to 6 weeks depending on severity of injury - sometimes sooner. It is important that strengthening exercises are done to restore stability and prevent re-injury. If the injury is not treated properly then there is a greater risk of re-injury and permanent instability which will eventually require surgery.

5. Facebook thumb ( text claw) !- yes seriously.

Facebook thumb or text claw is a symptom of overuse of the smartphone. This condition causes thumb pain and occurs mainly in women due to increased flexibility of the ligaments. Inflammation of the joint and tendons occurs possibly due to an inherent instability of the joint. We can provide expert assessment and treatment for this common, painful but correctable thumb injury.

Physiotherapy

There are a variety of options for thumb pain treatment. Typical conservative treatment options focus on reducing local joint inflammation and can include oral anti-inflammatory medication, wax baths, topical anti-inflammatory creams, and even injections. Physiotherapy utilising local joint and soft tissue mobilising techniques in conjunction with the right exercises for strengthening or stretching, can help considerably in the management and recovery from thumb pain. Wax therapy, therapeutic ultrasound, dry needling, splinting, ice, strapping and management strategies are all part of a comprehensive treatment approach.