Arthritis of the hands and thumb is very common. We use our hands and thumbs so much each and every day with all sorts of tasks, from work to activities of daily living like cooking, cleaning and even brushing our teeth!
How can we help?
We will do a subjective history of your complaints and determine what sorts of activities you have done, what your goals and and where your pain is limiting you
Then, we will do a thorough physical assessment of your hand and thumb to determine what sort of injury you have sustained, what joint or joints might be affected by sprain/strain, swelling, and possibly overuse and arthritis. Once we have determine which joint or joints and muscles are affected, we can help to determine an appropriate course of care for you.
Typical types of thumb and hand pain we treat, include:
Skiiers Thumb
- A traumatic injury to the ligaments of the thumb whereby there is excessive movement in the thumb and pain after injury – this can be quite severe and require surgery in some cases where the adductor aponeurosis gets caught and will prevent healing of the ligament
- requires immediate assessment to determine the severity of injury and whether specialist consult is needed
Osteoarthritis of the base of the Thumb
- the 1st Carpometacampal joint (CMC joint) is the most flexible joint in the thumb allowing us all of the main functions of the thumb.
- Ths is the most common joint of the hand to undergo osteoarthritis due to how much load and movement this joint goes through
- Can lead to loss of function and pain in the hand
- If caught early, can change how a person uses and loads through the thumb to help prevent progression to more severe arthritis changes
- Often correlated with hyper mobility in other joints of the thumb which puts more force through this joint
Ligamentous sprains in the hand and thumb, leading to hyper mobility in some joints
- Usually related to a fall on an outstretched hand (FOOSH)
- Can be correlated with a fracture of one of the carpal bones in the hand, or also associated with fractures ofthe wrist, include Colle’s Fracture and Smith’s Fracture
- Often requires splinting to assist healing, at least part of the time, and understanding of activities to avoid or be careful with
- Exercises and local treatment can help assist the healing and recovery process
Carpal bone instability, meaning excessive motion between carpal bones of the hand often due to trauma or ligamentous injury
- This can be related to traumatic fall on the hand (FOOSH) and can be a progression of ligamentous sprains that were not properly treated or managed. (Image)
- This could also be due to repetitive movements or loads with poor mechanics of the wrist and hand
- This could be worse in an individual with whole body hyper mobility syndrome ( often called “loose joints”)
- Requires identification of which ligaments or carpal bone is unstable and how severe it is in order to guide the management of this
- Proper assessment of the hand and wrist can help to guide the treatment process and recovery
Scaphoid bone fracture (carpal bone at the base of the thumb)
- Commonly fracture in falls on the outstretched hand (FOOSH)
- Very tender on palpation on the back side of the thumb in the “anatomical snuffbox” region
- Pain with tapping the thumb
- Pain with all thumb movements
- If fracture of the scaphoid present, may not show up on x-rays initially, may need to re-s-ray in 3 weeks
- If there is a fracture present in the scaphoid, it should be identified, as it can lead to avascular necrosis in the bone and bone death due to loss of blood supply if not properly managed or found on assessment
- If fracture, need to be splinted or casted for a period of time
Lunate bone fracture (small carpal bone in the centre of the hand near the wrist)
- Can be from FOOSH
- Can be related to peri-lunate instability
- can be related to Keinbock’s syndrome, or avascular necrosis of the lunate bone
Trigger Finger
DeQuervain’s Tenosynovitis
- Swelling and pain just on the wrist side of the thumb – painful with all thumb movements