CARING FOR THE PAINFUL THUMB 
“I want a pinch without pain” said a patient to me recently. Why do thumbs get so painful? We see so many patients who ask this question. Some people naturally have loose or lax ligaments that hold the bones together. These types of thumbs are very flexible and unstable. As time goes by, because the joint at the base of the thumb is so loose, it increases the wear and tear on this joint. Thumbs can become painful when ligaments remain stretched and the joint begins to slip. It hurts to pinch or use the hand for activities such as sewing, cutting meat, turning the key in the car, etc. This instability can eventually cause deformity of the thumb. It could also be osteoarthritis. This is the wear and tear disease of the joints. Osteoarthritis often appears first at the base of the thumb called the CMC joint (carpal-metacarpal). This is more common in women than men. Pinching is painful and often avoided. The pain with early osteoarthritis can change with the weather or with a change of activity. The joint can appear deformed and show signs of osteoarthritis on an x-ray. The conservative management program we are recommending here is directed at a diagnosis of ligament laxity (loose joint of thumb) and/or osteoarthritis. The thumb is very unique. Experts say 60% of hand use depends on a normal, healthy thumb. It is so valuable that when a thumb is lost, surgeons may replace it with a toe! The thumb can rotate in all directions. This ability, allows the thumb to do many things. The thumb needs to be flexible yet stable. Our patients with thumb pain all tell us what an inconvenience it is to not be able to use their thumbs! There are actually three thumb joints. Please see the illustration. The IP joint is closest to the tip. The MP joint is located in the middle. The CMC joint is at the base of the thumb. All the thumb bones sit on the trapezium bone of the wrist. The problem joint is usually the CMC joint when it is unstable or worn. It is supported by a system of five tough ligaments. The ligament on the palm side is thought to be the most important. Bone ends are covered with cartilage. Pain appears at the base of the thumb and the thumb can swell and become painful especially at the base. How do we as therapists help the thumb feel better so you can do activities? One of the things we do is widen the web space. You will find the thumb has difficulty moving away from the palm. This leads to deformity as time goes by. We work with the patient to widen and stretch the web space of the thumb. This decreases the pain. We also do exercises for stability. We target very specific muscles. Do not squeeze a ball or pinch things for exercise. That can hurt! We teach you exercises which hold the bone in place in the CMC joint at the base of the thumb. We can also retrain muscles to keep the bones from riding improperly on the wrist bone (trapezium). To reduce pain and swelling, we use a variety of techniques. One thing is a specialized custom thumb splint that holds the bones in place and allows the ligaments to tighten. Some splints are designed to support the wrist as well as the thumb. SOME TIPS TO PROTECT YOUR THUMBS FROM PAIN Don’t use your hand as a hammer Turning a key is easier when it’s mounted to a key holder Use full handle, spring loaded shears instead of regular scissors Washing dishes is easier using a large handled brush instead of a washcloth The larger the pen diameter, the less force to pinch is required Less strength is needed with a mounted, under the counter jar opener Don’t give up needle work, use a thumb splint If you or someone you know is bothered by a painful thumb, there is something that can be done. Ask your doctor for a referral or give us a call at TriState Hand & Occupational Therapy. We will work with you to reduce pain in your thumb and help you to be able to do your activities. Whether it’s sewing, bowling, writing, computer work or gardening; we can help you get it done. Give us a call today; you will be glad you did. |
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© Tri State Hand and Occupational Therapy, Inc
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