The human thumb makes up 50% of the function of the hand. Our ability to oppose our thumbs (touch the tips of each finger with the thumb) is part of what makes us uniquely human. Because our thumbs are so critical to everyday function, they often hurt and get overused.
When a patient complains about thumb pain, we look for the most common things first. Here is a brief description of each of these common reasons why thumbs hurt.
1. Thumb arthritis
Past age 65, 75% of patients have arthritis. Sometimes it doesn't hurt, but it doesn't take much pressure or trauma to cause an arthritic thumb to start hurting.
You may or may not have lumps and bumps or deformity as a result of the arthritis - sometimes it just hurts, with a deep aching pain inside the thumb.
The pain can be anywhere along the thumb, from the base of the thumb, near the wrist, to the end knuckle of the thumb, out by the thumb nail.
Other signs of arthritis include a crunching or grinding sensation you feel when you move the thumb, or pain that gets worse in the mornings or when you pinch or twist things.
Treatment for thumb arthritis
Treatment involves rest, gentle exercise to prevent stiffness, and medication. Splints can also help, but they should immobilize (stop motion) the thumb, not just the wrist. Over the counter rubs and creams may help with symptoms.
The bad news is that nothing will cure the root problem with arthritis, which is a cartilage problem. Surgery is the only method of treatment that gets rid of the grinding, unhealthy cartilage surfaces forever.
2. Trigger thumb
If the pain is on the palm side of the thumb, at the middle knuckle, your problem might be stenosing tenosynovitis, or trigger thumb. One tell-tale sign of this thumb problem is "triggering", sticking, locking, or catching in the thumb.
It's sometimes worse in the mornings, and the thumb either locks into a bent position at the end knuckle, or stiffens up to the point where you can't bend or straighten it out all the way anymore.
Treatment for trigger thumb
Trigger thumb can be cured with a shot of cortisone in the sheath of the tendon that bends the thumb. It doesn't require surgery very often, but the surgery is not difficult to recover from. Aside from injections, warm water soaks and anti-inflammatory medicines may help.
3. Thumb and wrist tendinitis - DeQuervain's tenosynovitis
This cause of thumb pain comes from inflammation along the tendons that extend the thumb into a hitchhiker's position. It's often common in new moms who lift their babies repetitively, and may be called mommy thumb.
If you have this tendinitis, you may have pain shooting along the top of the thumb, near the wrist, and into the back side of the forearm. One test for this is to grab your painful thumb with the fingers of that hand, and bend the wrist toward the pinky. This puts stress and strain on the tendons and will be painful in cases of tendinitis.
Mommy thumb treatment
Treatment with a splint and small shot of cortisone in the office is usually enough to cure the problem. Surgery is sometimes necessary, but trying injections first is reasonable. The hardest part of the treatment is avoiding aggravating activities in the first place!
4. Carpal tunnel syndrome
The carpal tunnel is a tight passageway on the palm side of your wrist that carries tendons and a major nerve into your hand. Compression, or pinching of this nerve can cause thumb pain, especially at night.
Usually numbness goes along with carpal tunnel syndrome. If you don't have any numbness at all, chances are you don't have nerve compression in the carpal tunnel. Patients with carpal tunnel syndrome will usually have tingling or numbness in the thumb, pointer finger, middle finger, and part of the ring finger.
Treatments for carpal tunnel syndrome, like wearing a wrist brace at night or doing slow, gentle finger stretches may help the thumb pain. Sometimes a cortisone shot is necessary as an "in between" step before considering surgery for carpal tunnel syndrome.
Thumb pain bottom line
The only one of these problems that can result in serious permanent disability is carpal tunnel syndrome. If you have thumb pain that's not getting better, see a doctor or other provider you trust and get it taken care of.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Christopher Henley - A board-certified orthopaedic surgeon specializing in the treatment of hand, wrist, elbow, and arm problems.
Join the Conversation