Expert Health Articles

Basilar Thumb Pain

Thumb pain is a common complaint that patients have in our orthopedic clinic. It is most common near the wrist at the “snuffbox” area or basilar region of the thumb. This pain can be very debilitating because it affects all aspects of daily living that require using the hand for grip. Grasping gardening tools, kitchen aids or racquets as well opening jars can be particularly problematic. A variety of causes for this pain can be identified: tendonitis, arthritis, fracture and nerve compression.

Tendonitis at the base of the thumb often involves the tendons that extend or straighten the thumb. The most common form of tendonitis is called “de Quervain's stenosing tenosynovitis,” an inflammation that can cause severe pain with gripping or grasping with the thumb. It involves two extension tendons of the thumb and can lead to excessive fluid around the tendon, inflammation of the tendons or even fraying and rupture of those tendons. Treatment is initiated with anti-inflammatory medications, bracing, stretches, rest, hand therapy and even injections. If nonsurgical treatment is ineffective, surgical release as a minor outpatient procedure may also be necessary. It is important to report any sudden loss of extension of the thumb urgently to your medical provider to avoid any long-term tendon complications.

Arthritis, most specifically osteoarthritis, affects the basal joint of the thumb. Osteoarthritis is the most common form of joint inflammation that can lead to cartilage loss, bone spurs, hardening of the bone (sclerosis) and joint debris (loose bodies). It causes pain with lifting and gripping. It is more common, but not exclusive in women in this location and can be occupationally disposed. It is treated with anti-inflammatory medications, injections, bracing and occasionally surgery for a new suspension or pad/spacer between joints. There have been a number of new surgical advancements and treatment of osteoarthritis at the base of the thumb.

Injuries to the wrist can often cause pain at the thumb base. A common and serious fracture involves the scaphoid, or navicular, bone of the wrist. The scaphoid bone is located on the same side as the thumb between the thumb and forearm and can refer pain to the base of the thumb. This can be a serious long-term injury if unrecognized since the scaphoid is the “vital link” between the forearm and hand. Injuries to this wrist bone require casting and potentially surgery. Loss of blood supply to the bone and non-healing of the fracture can be a concerning long-term consequence. The most common way to fracture this bone is to fall on an outstretched hand. Other fractures to the long bones of the forearm or the thumb base can also occur. It is important to have persistent wrist pain after a fall evaluated by a medical provider.

Nerve compression to the median nerve (carpal tunnel syndrome or CTS) may present as pain or weakness in the basal joint of the thumb. Loss of muscle mass (atrophy) can be a complication of long-standing CTS. Numbness can be another symptom but does not always accompany the thumb pain associated with CTS. Splinting, rest, anti-inflammatories, hand therapy, corticosteroid injections and sometimes decompressive surgery may relieve this pressure on the median nerve. This decompressive surgery has been performed minimally invasive and outpatient for years with excellent long-term results.

Let your medical professional know if you’re having these symptoms, so a diagnosis and tailored treatment plan can be set up for you to prevent serious long-term complications. You may be surprised how simple the solution may be!

 

James J. Davidson, MD, and Katie Fultz, PAC

Orthopaedic Surgery

Blanchard Valley Orthopedics & Sports Medicine