Ep 38: What's Really Happening When Your Thumb Hurts? How to Test for Thumb Tendonitis

Thumb tendonitis causes pain on the thumb side of your wrist due to inflammation of tendons that connect forearm muscles to the thumb. This common condition affects barbers, new mothers, and others who perform repetitive thumb movements, often coexisting with arthritis at the base of the thumb.

• Tendonitis of the thumb side wrist occurs when tendons become inflamed at a friction point where they pass through a compartment
• A positive Finkelstein's test (bending wrist toward little finger) indicates thumb tendonitis
• Over-the-counter wrist braces often cause more harm than good by placing pressure on inflamed areas
• Custom-molded splints properly immobilize without adding pressure to painful structures
• Treatment includes rest, specialized splinting, possibly steroid injections, and cold laser therapy
• Use cold running water instead of ice packs to reduce inflammation without adding pressure
• Morning is the only time heat therapy might be beneficial when inflammation is naturally lower
• Surgery may be necessary for cases persisting more than six months

Chapters

• 0:00 Introduction to Thumb Tendonitis
• 1:32 Diagnosing Thumb Tendonitis Pain
• 3:52 Problems with Store-Bought Braces
• 5:26 Proper Splinting and Treatment Options
• 7:21 Inflammation Management Techniques
• 8:07 Closing Thoughts and Future Services

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. Thank you for liking and subscribing to the channel and thank you for sharing this with others who are experiencing pain in their wrists, pain in their hands. I specialize in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder, as an occupational therapist and a board-certified hand therapist. Today let's talk about thumb tendonitis. It's a very common thing Barbers who are picking their thumbs up a lot with the scissors, people who are new mothers who are opening their hands forcefully to get underneath their kids' arms to pick them up. And you can see on my hand the tendons that really pop up significantly. They're connected to the muscles in the back of the forearm and they raise the thumb so those get inflamed. So remember, itis means inflammation, so tendonitis is an inflamed, painful tendon. Let's talk about the bones. So on the thumb side of the wrist there's something called the radial styloid on the radius bone right there and when you follow your thumb down to the base of your thumb and you feel that sharp, pointy bone right there, that bone also tends to get very inflamed and that's radial styloid, itis, again itis. It's inflammation of the radial styloid. That bony prominence gets very inflamed and the tendons right there. There's different wrist compartments. In this wrist compartment these tendons get very inflamed. There's a strap of ligamentous tissue and that strap holds the tendons down so they don't bowstring any more than what they are, so they don't pop up in this area, but that's a friction point where the tendons glide through and they get very inflamed. So if you're having pain on the thumb side of your wrist, there's a couple of reasons why this could be happening. One of the most common things is arthritis at the base of the thumb, where these two bones meet up together. If your pain is a little bit further down from the base of your thumb, if you follow your thumb and it kind of steps off right there, if that's tender in the front and on the side on the back, most likely you're dealing with some significant osteoarthritis at the base of your thumb, which is, by the way, one of the most common places for significant degenerative arthritis to affect the body. Now, getting back to the tendonitis, when you follow that down further and it's soared down through here, it's probably tendonitis of the thumb side of the wrist. Now a test that we do in the clinic is for the patient to hold their thumb and then bend their wrist down toward the little finger, and when you bend that down and that hurts a lot right there, that's called a positive Finkelstein's test. So let's back up again Tenderness to palpation or tenderness to touch, firm touch and also Finkelstein's test, okay. Now another thing that I do in the clinic is that I will slide my finger down from the tip of the thumb past the first knuckle, and then tell the patients push up against my finger. That is isolating one of those tendons right here and if that hurts, that's a positive sign for tendonitis in the thumb side of the wrist. Also, I'll resist another specific muscle. I'll have them push, bring their thumb away from their palm and I'll resist that. If that hurts, that's also in the same compartment, all right.

Speaker 1: 3:37

So what I'm looking for in the clinic is is evidence of what is the source of the problem, and more often than not it's both. It's the arthritis and the tendonitis. We can talk about treatments later. One thing I want to talk about is over-the-counter braces. So I pull these out of people's braces all the time they go to the store. They're looking to get something to help decrease their pain and they'll get an over-the-counter brace that has a stiffener bar in it. And guess where that stiffener bar is? It's right over. I happen to have muscles and tendons right here. It's right over the thumb side of the wrist. It's right on that sharp bone area that I showed you on the bony skeleton here. It's right over that sharp bone area. It's grinding into that. It's placing pressure on the tendons. I start showing my frustration because they absolutely for sure cause more harm than good. So what I do in the clinic is I'll start with a nice custom molded I made this on myself best I could nice custom molded brace that immobilizes this area so the patient can use their hand they can oppose to their fingertips, has some nice padding inside. It goes on very easy. You put it over the thumb and then just lay it over the forearm. It immobilizes all their correct muscles because patients can still use their fingertips to grasp things and pick things up.

Speaker 1: 5:07

As symptoms decrease, then I decrease the size of the splint. So now I'm still immobilizing the thumb and what I'll do is I'll cut the forearm portion off of the splint and I'll turn it into a hand-finger orthosis, allowing the wrist to be free, and then, of course, the next step is to fully remove it. Now some people have a more prominent bony area here, that radial styloid. It sticks out more on some people than others, so usually what I'll have to do is just use a heat gun on the on the splint and bubble that right out and then I'll put pads on either side inside of the splint to really bridge the area. So absolutely nothing is touching it. Because, again, if anything is touching that or rubbing on it, it's it's very, very problematic and the problem will just not go away.

Speaker 1: 5:54

Now if you've been experiencing this for six months, a year or longer, most likely you're going to need the surgery just to go in there and loosen everything up and remove pressure off of those tendons. Now, if you've been dealing with this for a few months or even as long as six months, you know everybody responds different. The longer it goes on, the harder it is to treat, just like anything else. But an excellent treatment is to first get an injection, a steroid injection, and then go to the therapist, get a splint and then we do some certain very light stretches and traction. We use cold laser. There's a lot of different treatments but mostly we just have to allow that inflamed, aggravated, irritated area to rest and to calm down.

Speaker 1: 6:46

Again, on the model we have the red muscles here's the thumb muscle turning into tendon and then going down to the thumb, and these get very, very irritated along with the bone. So the tendons which connect muscle to bone, the bone itself a lot of inflammation. And we also focus on reducing the inflammation with appropriate cryotherapy or cold therapy, such as cold running water which does not put the pressure of a cold pack on the wrist. I don't want anything laying on that wrist where it's putting pressure on the bone. Nothing should be laying there. Cold running water just encircles or envelops the whole thing reduces inflammation, takes 10 to 20 seconds, right when it's deeply cold. It's done. It's so easy and extremely effective On these patients.

Speaker 1: 7:34

Initially I don't have them use heat at all. Eventually, when we start using a little bit of heat like a heating pad wrapped around the wrist and hand, it'll be in the morning only when the inflammation is at its lowest point because the patient's been resting all night in bed, hopefully for about eight hours, not doing much. Then when they get up in the morning it'll be more stiff than anything else, not as painful. That's when we can get away with using the benefits of heat for increasing blood flow, loosening up the tissues without making worse the inflammation. Thank you for listening. Thanks for watching. Worse the inflammation. Thank you for listening. Thanks for watching. Share this information with people. The more people that understand this, the better. Eventually, I'm going to be opening myself up to meet with people online so we can talk about their symptoms and so I can help people get to where they need to be. Thank you very much.