Thumb and wrist joint pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Carpal tunnel syndrome is a common cause of wrist pain.

You may feel aching, burning, numbness, or tingling in your palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may extend up to your elbow.

Carpal tunnel syndrome occurs when the median nerve gets compressed at the wrist because of swelling. Risk factors are:

• Repetitive motion with your wrist like typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool.
• Pregnancy, menopausal status, or obesity.
• Diabetes, premenstrual syndrome, underactive thyroid, or rheumatoid arthritis.

For carpal tunnel syndrome, you may need to make adjustments to your work habits and environment:

• Make sure that your keyboard is low enough that your wrists aren't hyperextending or hyperflexing while you type.
• Take plenty of breaks from activities that aggravate the pain. When typing, stop often to rest the hands, if only for a moment.
• An occupational therapist can show you ways to ease pain and swelling.
• Over-the-counter pain medicationscan relieve pain and swelling.
• Various wrist rests are designed to relieve wrist pain.
• You may only need to wear a wrist splint at night. This helps reduce the swelling. If that doesn't work, wear the splints during the day and apply hot or cold compresses periodically.

Wrist and thumb pain with bruising and swelling is often a sign of an injury. The signs of a possible broken bone include deformed joints and inability to move the wrist, hand, or a finger. Other common injuries include sprain, strain, tendinitis, and bursitis.

Arthritis is another common cause of wrist pain, swelling, and stiffness. There are many types of arthritis. Osteoarthritis occurs with age and overuse. Rheumatoid arthritis generally affects both wrists. Psoriatic arthritis accompanies psoriasis.

The joint at the base of the thumb which allows for the pivoting motions of the thumb is referred to as the basal joint or thumb CMC (carpometacarpal) joint. Basal joint arthritis is common in people who have osteoarthritis. The basal joint of the thumb, or carpometacarpal joint, is made up of a carpal or wrist bone (trapezium) and the first or metacarpal bone of the thumb. This joint is near the wrist and under the fleshy part of the thumb.

The joint is held in position by ligaments and muscles surrounding the joint. Disruptions of the joint surface or the supporting ligaments can lead to slipping of the joint (subluxation) as well as pain and swelling.

Symptoms of arthritis in the base of the thumb are pain and swelling about the thumb and wrist, particularly with grasp and pinch. These symptoms may appear the first thing in the morning and be present for a half hour or so before the thumb "loosens up." They might then subside throughout the middle of the day, only to return with a "dull aching" type of pain towards the end of the day or after vigorous use. A "bump" may appear at the joint, due to subluxation of the base of the metacarpal bone as the ligaments loosen.

X-rays help determine the severity of the disease.

Treatment of the condition depends upon the symptoms and stage of the disease. For mild-to-moderate symptoms of pain and swelling, treatment consists primarily of anti-inflammatory medication, rest, splinting, and education. Various splints to support the joint can be helpful.

Because basal joint arthritis is such a common problem, many types of surgical procedures have been developed to deal with it. Surgery generally falls into three main categories; one involves fusion of the two bones making up the joint, thereby eliminating painful symptoms. A potential drawback is some loss of motion and some stiffening of the thumb joint.

The other major category of surgical correction involves removal of the arthritic surfaces and insertion of material between the two ends of the bones. Many types of materials have been developed; the most frequently used are a forearm tendon from the patient or a synthetic plastic rubber disc. Each type of surgery has its potential benefit and drawbacks, and each person's requirements are different.

Another option is arthroscopic debridement followed by viscosupplentation. This is useful for patients where there is pain but no subluxation.

After surgery, the doctor may prescribe a course of therapy designed to increase the mobility and strength in the thumb following the surgery.

Infectious arthritis, a serious type of arthritis, is a medical emergency. The signs of an infection include redness and warmth of the wrist, fever above 100°F, and recent illness.

Other common causes of wrist pain include:

Gout -- this occurs when uric acid forms crystals in joints and causes inflammation.
Pseudogout -- this is when calcium pyrophosphate deposits in the joints (usually the wrists or knees), cause pain, redness, and swelling.

De Quervain's disease is a painful inflammation of tendons that extend the thumb. The tendon sheaths become inflamed and trap the tendons. The result is pain at the thumb side of the wrist joint.

The condition can occur gradually or suddenly; in either case, the pain may travel into the thumb or up the forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects.

Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people feel pain if direct pressure is applied to the area.

Overuse, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease.

De Quervain's affects women eight to 10 times more often than men.

The test most frequently used to diagnose de Quervain's disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed across the palm. When the wrist is suddenly bent toward the side of the small finger, the pain is reproduced.

Treatment usually involves wearing a splint that includes your wrist and thumb 24 hours a day for four to six weeks to immobilize the affected area. Ice may be applied to reduce inflammation and your doctor may give you anti-inflammatory medication. If symptoms continue, glucocorticoid injection administered using ultrasound guidance may be performed.

Surgery for de Quervain's disease is rarely needed.

Hydrodissection tendon release is a simpler procedure using a small needle with ultrasound guidance. A relative large amount of fluid is injected into the tendon sheath to "free up" the inflammation and adhesions. This technique often prevents having to have surgery.

For a recent injury:

• Rest your wrist. Keep it elevated.
• Apply ice to the tender and swollen area.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Wear a splint for several days. Wrist splints can be purchased at many drugstores and medical supply stores.

For non-infectious arthritis:

• Flexibility and strengthening exercises are important. Work with a physical therapist to learn the best and safest exercises for your wrist.
• Do the exercises after a hot bath or shower so that your wrist is warmed up and less stiff.
• Do not perform exercises when your wrist is inflamed.
• Make sure you rest the joint adequately. Both rest and exercise are important when you have arthritis.

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