Dr Grant responds: The human thumb is an incredible digit that endures a significant amount of strain from daily activities. Its ability to oppose the other fingers played a major role in human evolution over two million years ago. This unique feature allowed us to carry heavy objects and perform complex tasks like writing, sewing, and crafting tools using stones.
Without a comprehensive examination and understanding of your thumb pain history, I can suggest a few common thumb issues. The thumb consists of three joints: the carpometacarpal (CMC) joint near the wrist, the metacarpophalangeal (MCP) joint that forms the thumb, and the interphalangeal (IP) joint near the nail.
Trigger thumb is a common cause of thumb pain in adults and is often associated with repetitive strain injury. This condition is characterized by a clicking, catching, or locking sensation when fully closing the finger. It occurs due to inflammation of the flexor pollicis longus tendon, making smooth gliding difficult and resulting in localized pain around the MCP joint.
MCP joint strain is another potential cause of thumb pain, which presents as pain, swelling, or tenderness on either side of the joint along with limited flexion.
De Quervain’s tendinopathy is commonly observed in females over 30 years old and new mothers. Symptoms typically arise 4-6 weeks after giving birth. This condition involves inflammation and pain in the tendons on the thumb side of the wrist, often caused by repetitive strain. Based on the information provided, this seems to be the most probable diagnosis.
The initial step in managing trigger thumb, MCP joint strain, or De Quervain’s tendinopathy is to rest, limit, or modify activities that aggravate the condition. Wearing a splint to reduce joint movement and taking non-steroidal anti-inflammatory (NSAID) medication such as ibuprofen can help alleviate pain and swelling. Splints are typically worn for three to six weeks and should maintain a slight bend in the MCP joint.
If significant improvement is not observed after six weeks, it is advisable to consult a GP with expertise in joints, an orthopedic surgeon, or a rheumatologist for a potential local steroid injection. Up to three injections can be administered at least six weeks apart if the symptoms have not improved by at least 50%. In severe cases, a surgical release may be considered as a last resort.
In rare instances, thumb pain and swelling may be caused by underlying inflammatory arthritis conditions like rheumatoid arthritis or reactive arthritis. These conditions can usually be distinguished from the previously mentioned issues based on the swelling and pain occurring along the long axis of the affected finger, resulting in limited and painful extension. Treatment for inflammatory arthritis involves stronger medication to address the underlying condition effectively.
Dr Jennifer Grant is a GP with Beacon HealthCheck.
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