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more articles by Carney Young, Kimberly , MD  |  author's bio

Getting a Grip on Painful Thumbs

Getting a Grip on Painful Thumbs

By Kimberly Carney Young, MD


There are numerous common conditions that cause pain and restricted movement in the thumb. Two of the more common diagnoses are: basal joint arthritis, which is seen most often in older women; and de Quervain’s syndrome, which is a form of tendonitis seen in all ages and is activity related. Both conditions are much m0re common in women than men, and both can be treated very successfully.


What are the symptoms of basal joint arthritis?


Basal joint arthritis occurs in the carpometacarpal joint, which is at the base of the thumb where it joins the wrist. People with basal joint arthritis have trouble performing simple tasks, such as grabbing doorknobs, opening jar lids, and holding larger objects. They experience pain and lose strength in the affected hand. A telltale bump typically develops at the base of the thumb, and the thumb gradually draws into the side of the index finger, making it difficult to spread the thumb and finger apart.


How is basal joint arthritis treated?


For the majority of people, this painful problem can be addressed conservatively with treatment options such as steroid injections, splinting, and physical therapy with a hand specialist. However, when these measures fail to provide adequate relief, hand surgery can be a safe and effective option. The surgical procedure, basal joint arthroplasty, is performed by an orthopedic surgeon or a hand surgeon with specialized training in hand and upper extremity problems.


During basal joint arthroplasty, the surgeon removes the small bone that has been destroyed by the wearing away of cartilage over time. Once the bone is removed, the surgeon uses a surrounding tendon to hold the thumb in the proper position. Basal joint arthroplasty is one of the most successful hand surgery procedures, with over 30 years of d0cumented patient follow-up and outcomes.


What is de Quervain’s syndrome?


De Quervain’s is a form of tendonitis that causes pain on the thumb side of the wrist, which is a slightly different location than basal joint arthritis. We commonly see new mothers with de Quervain’s, brought on by the repetitive motion of lifting up the new baby.


The symptoms of de Quervain’s are sharp pain when turning the wrist or grasping an object; essentially the same kinds of activities that aggravate basal joint arthritis can bring on de Quervain’s. Similar to arthritis, the majority of people with de Quervain’s can find sufficient pain relief through conservative treatment options such as nonsteroidal anti-inflammatory medications, steroid injections, and splinting.


When is surgery appropriate?


The tendons that lift the thumb glide through a sheath, or tunnel, of tissue. When the tendons become inflamed and swollen, they don’t slide easily through that protective sheath. In more serious cases of de Quervain’s syndrome, it may be necessary for a hand surgeon to open the sheath and release the pressure on the inflamed tendons. This surgery is very effective in relieving the pain. Patients are usually splinted for two weeks after surgery, followed by a return to activities.


Dr. Carney Young is an orthopedic surgeon with fellowship training in hand surgery at the renowned Hospital for Special Surgery, an affiliate of Weill Cornell Medical School in New York City. She is on the medical staff of Cayuga Medical Center and is in practice with Dr. Dirk Dugan, Dr. Joseph Mannino, and Dr. Brett Young at Orthopedic Services of Cayuga Medical Associates. She can be reached at 607-272-7000.



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