Thumb pain can become quite a hinderence to activities of daily living. Our thumbs have a lot of motion to give us the ability to oppose and grasp onto objects. However, as we age, there are some common degenerative changes that can occur to the thumb. They are:
1. Arthritis of the base of the thumb. This happens more commonly in females over the age of 50 and commonly presents as pain with trying to open jars, open doors, or anything that involves grasping onto objects. It occurs as the ligaments at the base of the thumb degenerates over time. Occasionally, it can be caused by a previous injury and it's called post-traumatic arthritis. There are great options including a thumb brace, medications such as Advil or Aleve, modifying one's activities, and injections. Those options above relieve symptoms but do not take away the underlying arthritis. Surgery can "take away" the arthritis by removing a bone in your wrist that's arthritic. Generally, a tendon reconstruction is done at the same time. Recovery after surgery involves a temporary splint for the first 2 weeks, followed by a removable splint usually for another 4 weeks or so. The procedure is named "trapeziectomy with LRTI" (ligament reconstruction tendon interposition).
2. Trigger thumb. This is the same entity as trigger fingers but involving the thumb. Typically you'll get popping and locking of the finger, usually worse in the morning. It's associated with grasping onto things tightly. It's also more common in patients with diabetes and systemic inflammatory conditions like rheumatoid arthritis. Treatments include activity modification, medications like Advil or Aleve, splinting the finger, or more effectively injections. I can give 2 injections typically and if there are still symptoms, then a trigger thumb release is typically warranted. This surgery can be done with pure local anesthesia without need for sedation. Sedation is optional and patients have the option.
3. Sprains or fractures. A variety of sprains and fractures affect the thumb. The most typical sprain is one that involves the ulnar collatera ligament of the metacarpal phalangeal joint (UCL injury). It's been named Gamekeeper's thumb in the past and is sometimes called Skiier's thumb. Depending on the severity of the injury, surgery can be warranted. Sometimes with a grade 1 or 2 sprain, a thumb brace/cast can be worn. Fractures of the thumb can occur with a direct blow or if the finger is accidentally streched in an abnormal position. Depending on the type of fracture, additional imaging such as a CT may be necessary. Treatment options include bracing/casting or surgery.
There are numerous other causes of thumb pain. If you your thumbs bother you, feel free to make an appointment with us.
