Causes of Thumb Pain and Treatment Options

Thumb pain can occur from damage to various structures in your hand, including ligaments, tendons, bones, and nerves. Common conditions that cause thumb pain include arthritis, tendonitis, trigger thumb, carpal tunnel syndrome, and ligament injuries. Thumb pain can come on suddenly or develop over time from overuse of the thumb joints and muscles.

This article discusses thumb pain, including causes, diagnosis, and treatment options.

Thumb Pain Causes

Thumb pain can significantly interfere with daily tasks, such as:

• Gripping
• Pinching
• Getting dressed
• Turning a key
• Writing
• Typing
• Carrying a bag by the handles

Thumb pain can result from various conditions, such as arthritis, de Quervain's tenosynovitis, trigger finger, skier's thumb, or carpal tunnel syndrome.

Thumb Arthritis

The base of the thumb—called the carpometacarpal joint, or CMC—is a common site for arthritis.

Osteoarthritis (OA) can develop in the thumb. This condition gradually occurs from joint wear and tear. The cartilage that provides padding between bones in the joint slowly wears down, eventually causing the bones to rub against each other.

Osteoarthritis can affect one or both thumbs. It is often more severe in your dominant hand.

In addition to pain, OA in the thumb can cause:

• Decreased grip and pinch strength
• Grinding with movement of the thumb
• Joint deformity
  
• Stiffness
• Swelling at the base of the thumb
  

Thumb pain can also occur with rheumatoid arthritis (RA)—an inflammatory arthritis that occurs when the body's immune system mistakenly attacks the inner joint tissue known as synovium. Rheumatoid arthritis usually causes pain in both thumbs at the same time.

De Quervain's Tenosynovitis

De Quervain's tenosynovitis is caused by inflammation of tendons that attach to the base of the thumb and continue along the thumb side of the wrist. The two muscles affected are the extensor pollicis brevis (EPB) and abductor pollicis longus (APL). These muscles lift the thumb and move it out to the side.

De Quervain's tenosynovitis occurs from overuse of the thumb and wrist. The primary symptom is pain along the thumb side of the wrist. You might also have swelling. This condition can make it difficult to move your thumb and cause a snapping sensation when you grip or twist your wrist.

Trigger Thumb

Trigger thumb (stenosing flexor tenosynovitis)—when trigger finger affects the thumb—is a common cause of thumb pain. It affects the flexor tendon that bends the thumb and can also affect any of the other fingers.

Each flexor tendon travels through a tunnel called a tendon sheath. Structures called pulleys keep the tendon sheath in place along the finger bones.

Trigger finger develops when the pulleys become inflamed. This makes it difficult for the tendon to slide through the sheath as you bend and straighten your thumb, causing a "catching" or "popping" sensation. In severe cases, you might have to use your opposite hand to straighten your finger out after you bend it.

Trigger thumb can also cause a nodule, or "bump," on the tendon, which you can feel at the base of the thumb.

Skier's Thumb

Skier's thumb is damage to the ulnar collateral ligament (UCL) of the thumb. It is typically injured from a fall on an outstretched hand when the thumb bends too far backward—an injury commonly occurring while skiing.

Skier's thumb causes pain on the inside border of the base of the thumb.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that develops from compression of the median nerve in the wrist. In addition to the median nerve, the carpal tunnel contains nine tendons connected to muscles that move the fingers and thumb.

This condition typically develops from overuse of the finger muscles, causing inflammation in the tunnel, which puts pressure on the median nerve.

Carpal tunnel syndrome can cause pain, tingling, and numbness in the thumb. Symptoms also commonly affect the index finger, middle finger, and the ring finger's inner border.

Treatment for Mild Thumb Pain

Mild thumb pain can often be resolved with conservative interventions.

These can include:

• Rest: Avoid activities that increase your pain.
• Splinting: Various splints are available to support your thumb and reduce pain during daily activities.
• Heat or ice: Applying heat or ice to your thumb can help decrease pain. Heat is helpful for chronic or aching pain at the end of the day, while ice is more appropriate during the first 72 hours after a thumb injury.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as Aleve (naproxen) and Advil or Motrin (ibuprofen) can help reduce symptoms of thumb pain.
• Steroid injections: This treatment involves injecting anti-inflammatory medication directly into the thumb or wrist.

Hand therapy is another standard treatment for thumb pain, often provided by a certified hand therapist.

Benefits of working with a certified hand therapist can include:

• Pain-relieving options such as ultrasound, cold laser, and electrical stimulation
• Tailored recommendations for proper splinting of your specific injury
• Personalized stretches and strengthening exercises for your thumb
  

Diagnosing Thumb Pain That Doesn't Go Away

A healthcare provider will first assess your thumb pain with a physical exam. However, a provider may order imaging—X-rays, magnetic resonance imaging (MRI), and computed tomography (CT scan)—to determine which structures are causing the pain.

Some thumb pain conditions can be diagnosed with special orthopedic tests. For example, de Quervain's tenosynovitis—pain that occurs when the thumb is tucked under the fingers, and the wrist is tilted away from the thumb—can be diagnosed with the Finkelstein test (bending your thumb across the palm and bending your fingers down over the thumb).

Treatment for Chronic Thumb Pain or Serious Injury

Thumb pain that doesn't improve with conservative treatment or occurs from a serious injury might require surgery. Severe thumb OA is treated with CMC arthroplasty. During this procedure, a small bone at the base of the thumb—called the trapezium—is removed.

Trigger thumb, de Quervain's tenosynovitis, and carpal tunnel syndrome can all be treated with surgery to release the structures and apply pressure to the involved tendons or nerves.

A significant or complete tear of the ulnar collateral ligament with a skier's thumb injury is also fixed with surgery.

Self-Care to Ease Thumb Pain

Altering how you perform your daily activities can reduce your thumb pain risk. Simple modifications can decrease pressure through your thumbs, such as:

• Lift items with your palms rather than grabbing them with your fingers and thumb.
• Loop grocery bags over your forearms rather than gripping the handles.
• Use pencils, pens, and other utensils with larger barrels or grips to decrease pressure on your thumb muscles.
• Take frequent breaks during repetitive activities such as typing, gaming, gardening, or crocheting.

Thumb Exercises

Gentle exercises in a pain-free range of motion can help you maintain thumb mobility. Perform each of the following movements 10 times:

1. Bend your thumb into your palm, then lift it in a thumbs-up position.
2. Touch the tip of your thumb to the tip of each finger.
3. Bring your thumb out to the side (like you're grabbing a cup) and back toward your hand.
   

Summary

Thumb pain can interfere with daily activities that require repetitive movements, gripping, and pinching. Thumb pain can occur with acute injuries, such as a ligament tear, or chronic conditions, such as tendonitis, arthritis, and nerve compression. Conservative treatment for thumb pain includes home remedies and medications.

Severe thumb pain or trauma might require surgery. Consult your healthcare provider for an accurate diagnosis of the cause of your thumb pain and treatment options.