In this HealthHearty article, we shall discuss the identifiable symptoms, possible causes, and available treatment options for thumb tendonitis. Have a look…
A tendon is the tissue that connects the muscles and the bones. The condition of an inflamed tendon is called tendonitis (also spelled as tendinitis). It most commonly occurs as a result of physical trauma, repetitive stress, or inflammatory rheumatic diseases like gout or reactive arthritis. The following is a brief discussion relating to tendonitis of the thumb.
In the human body, tendons are rope-like structures that attach the muscles to the bones. Thus they allow movement of the bones along the joints, during muscle contraction and expansion. They are encased by a thin and slippery soft-tissue, known as synovium, which makes it possible for the tendons to move easily through a fibrous tunnel known as the sheath.
Tendonitis implies inflammation and subsequent swelling of the tendons and/or thickening of the sheath which restricts the smooth movement of the tendon, increasing friction and leading to pain.
The forearm comprises two long bones which connect to the small bones of the wrist, fingers and thumbs. Several muscles responsible for controlling movement, originate from the forearm and connect to the bones of the fingers and thumb via tendons.
Tension is placed via the respective tendons when the thumb muscles contract. When this occurs repeatedly and in excess, or in an intense, forceful, or unnatural manner, it may result in damage to the tendon and associated mechanism. This subsequently leads to inflammation, degeneration and swelling to one or more of the tendons associated with the thumb – a condition known as thumb tendonitis.
The following are the major symptoms caused by thumb tendonitis:
- The first and most easily identifiable symptom of thumb tendonitis is pain, which is mostly felt on the thumb side of the wrist. This pain generally appears gradually but in some cases is known to appear suddenly. If the tendonitis is severe, the pain can radiate up the wrist and even affect the entire hand.
- Another symptom of tendonitis is swelling of the affected region, which may sometimes also be accompanied by a fluid-filled cyst. The pain and swelling typically restrict the comfortable movement of the thumb making it difficult for one to carry out even the simple daily activities like holding and grasping.
- A ‘snapping’ or ‘catching’ sensation might be experienced when the thumb is moved in certain ways.
- The patient will usually experience reduced grip-strength and might be prone to frequently dropping objects held with the affected hand.
- Sometimes pain may be felt in the neck or upper back, on the same side as the affected thumb.
- In the early stages, pain will usually be felt only at night or early in the morning, and subside when the body warms up during the day. As the condition progresses, sharp stabbing pain sensations will be felt when performing certain movements, and a dull numbness/ache will continue to persist afterwards.
- Externally applying pressure to certain parts of the thumb too may cause pain indicating the presence of tendonitis.
The most common reason behind thumb tendonitis is the repeated performance of a new activity, to which the body isn’t acclimated.
Such activities may include sports, weight-training, chopping wood, brick-laying, hammering, sewing and knitting, prolonged writing or computer usage.
Thumb tendonitis also results from excessively forceful activities such as heavy lifting and gripping. It also occurs due to accidents involving a fall, fracture, serious muscular strain, etc., resulting in an abnormal movement of the thumb.
Typically this condition is observed in new mothers, who frequently have to position their thumb awkwardly while nursing their babies. The hormonal changes occurring in the bodies of expectant and nursing mothers, is also a possible reason behind thumb tendonitis.
The likelihood of developing thumb tendonitis is greater in patients who have preexisting back, shoulder, wrist etc. conditions, or have a history of injury to these areas.
To confirm the presence of tendonitis in the thumb, a doctor generally conducts a Finkelstein’s test. In this test, the doctor will ask the patient to make a fist with his/her fingers over the thumb. Usually, thumb tendonitis causes swelling and tenderness and so the patient will find it painful and uncomfortable to assume this position. The doctor may also suggest getting an X-Ray or MRI done to better access the degree of the injury.
The foremost aim of the treatment, is to alleviate the symptoms of tendonitis, and so the doctor will probably suggest that the patient avoids using the affected thumb as much as possible. He may also recommend a splint to provide support and comfort allowing the healing to take place effectively.
Following the R.I.C.E. protocol, which involves resting the thumb, regularly icing it, using compression bandage and keeping the arm elevate, in the initial stages of the injury (first 3-4 days), will help to significantly reduce the symptoms and facilitate the healing process.
Since the basic reason behind the discomfort is inflammation of the tendon, medical treatment will typically include anti-inflammatory medication, which will probably need to be administered orally.
The treatment will also probably require the patient to undertake physiotherapy. This will involve procedures including specific massages, trigger point releases, joint mobilization of the wrist, fingers, thumb and hands, electrotherapy, ultra-sound treatment etc., which will assist in reducing the inflammation and associated swelling.
Taking sufficient rest and medication is most important to relieve the pain, swelling and discomfort. One must try to avoid performing those movements frequently that hurt the thumb. Ignoring the symptoms and carrying on with such activities will cause the condition to aggravate further and delay the healing. The compliance of the patient and adherence to medical advice will play a key role in effective and complete treatment.
In the later stages of rehabilitation, when the pain subsides sufficiently, the physiotherapist will put the patient on a strengthening and flexibility routine. This will involve low to moderate intensity painless exercises (with or without weights), which will help the patient in regaining the full range of motion and lost strength. It will also make the thumb and associated muscles and tendons strong enough to resist future injuries. To obtain their full benefits, the patient will typically be required to perform these exercises regularly at home.
In the final stages, when the symptoms complete disappear and with the doctor’s and physiotherapist’s approval, the patient will be able to return to the regular routine and slowly and gradually be able to make full use of the thumb again.
There may be a few instances where the use of medication, resting and physiotherapy will not be able to alleviate the symptoms. In such severe cases of thumb tendonitis, the doctors might prescribe the following higher level treatments.
Corticosteroids: Corticosteroid injections may be administered to the tendon sheath to reduce the inflammation and swelling, and speed up the healing process.
Surgery: If everything else fails and the injury is severe enough, the patient might have to undergo surgery, which will involve opening the thumb compartment or covering, so that the irritated tendon gets enough space to accommodate itself. After the surgery the patient will typically take a couple of weeks to recover and gain his strength back.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be replaced for the advice of a medical professional.