What Arthritis Problems Cause Severe Pain in the Thumb?

There are different problems seen in a rheumatologist's office that can cause thumb pain.

Probably the most common is what is called De Quervain's tenosynovitis. This kind of tendinitis is due to repetitive motion involving the thumb. Actions such as using pruning shears, writing, pinching, knitting, lifting weights, and typing can cause this.

Another situation is that of new mothers. Because of the repetitive motion involved in lifting and carrying a baby, new mothers can also develop this condition.

Symptoms of De Quervain's include swelling, pain, and tenderness involving the radial (thumb side) of the wrist and thumb. The pain can be so severe that the patient cannot use their thumb at all.

On examination, there is tenderness noted along the thumb side of the wrist. Also, there is a positive Finkelstein's maneuver. The physician has the patient bring the thumb across the palm of the hand. Then the patient is asked to fold their fingers over the thumb. The hand is then pushed towards the little finger side of the wrist. This stretches the tendons along the thumb side of the wrist and causes severe pain.

While the diagnosis is often made on clinical grounds, it can be confirmed by either diagnostic ultrasound or magnetic resonance imaging (MRI).

There is a simple reason for making sure the diagnosis is correct. That reason is because there is another type of tendinitis that looks like De Quervain's tendinitis. This condition is called intersection syndrome.

Intersection syndrome involves tendons that are very near the tendons that cause De Quervain's disease. Intersection syndrome also arises from repetitive motion and is often seen in very active people.

One other condition that can be confused with De Quervains disease is osteoarthritis at the base of the thumb. Location of symptoms is very similar in both conditions.

One other type of tendonitis can occur on the palm side of the thumb. This is called stenosing tenosynovitis- or" trigger thumb." The patient may have difficulty bending and straightening their thumb because it catches.

Once the diagnosis of DeQuervain's disease or intersection syndrome is established, treatment of this set of conditions- which are considered forms of arthritis- can begin. Treatment of these disorders include splinting, anti-inflammatory medication, physical therapy, and sometimes, corticosteroid injection. Steroid injection should be administered using ultrasound guidance. This usually provides rapid relief.

In those patients who do not respond to the above measures, needle tenotomy with platelet rich plasma (PRP) administration using ultrasound guidance is often each effective.

For trigger thumb, steroid injection usually works. In those patients who continue to trigger, a release of the small pulley that causes trapping of the thumb tendon can be accomplished using a small needle with ultrasound guidance. In rare instances, open surgery is required.