QUESTION: A 32 year old male was skiing whilst on holiday and fell on his outstretched hand, resulting in his thumb hyperextending. It is now painful and swollen. His thumb feels unstable and he is having difficulty turning keys, holding his coffee mug, and writing. What is the problem?
What Is It?
Thump pain refers to any pain or discomfort in the thumb region including bones, muscles, joints and ligaments. It can be caused by a number of different issues, and is not always result of direct impact on the thumb. The scenario above is a classic case of skier’s thumb, but this is just one of many possible causes of thumb pain.
Causes of Thumb Pain
There are numerous causes of thumb pain, some serious and some easily treatable. Here are some of the most common:
Skier’s thumb: Skier’s thumb is where an injury occurs to Ulnar Collateral Ligament of the metacarpophalangeal joint of the thumb. The ligament can avulse a piece of bone off from its insertion or tear. It often occurs when someone falls on an outstretched hand and the thumb is hyperextended and abducted away from the palm.
DeQuervain’s Syndrome: DeQuervain’s Syndrome is the irritation of the two tendons that insert at the base of the thumb as they pass through the extensor sheath. The extensor pollicis brevis and abductor pollicis longus muscles are responsible for lifting the thumb up and away from the palm.
Broken thumb: A broken thumb refers to a crack or break in any of the two phalanges in the thumb. A broken thumb can cause quite a bit of pain, swelling and discomfort.
Broken hand: A broken hand is when a break/fracture occurs to one of the bones in your hand. A break in the 1st metacarpal can cause much pain and discomfort in the thumb.
Arthritis of the thumb: Thumb pain is the most common, and usually the first, symptom of thumb arthritis. Stiffness, swelling and tenderness at the base the thumb will usually follow. It will generally be more difficult to grip objects or pinch items such as keys.
Carpal Tunnel Syndrome: Carpal tunnel syndrome is the compression of the median nerve as it passes through the carpal tunnel. Compression of the nerve can cause symptoms such as numbness, pins and needles, tingling, swelling, pain and weakness in the thumb.
For many causes of thumb pain, an X-Ray or MRI may be appropriate. Your hand therapist will let you know if this is required.
Many of the common causes of thumb pain can be managed by a hand therapist. Treatments include hand splints, which will immobilise the area in order to reduce swelling and pain, graduated exercises for range of motion, nerve gliding and strengthening, education about conditions and care, and exercises for non-involved joints.
Surgical treatment maybe required for more serious conditions. Your therapist can discuss this with you and your GP can arrange a referral to a hand surgeon if required.