Chiropractor Chandler AZ
Pain at the base of your thumb that becomes worse over time and is exacerbated by activities such as writing and gripping is something you shouldn’t ignore. The most common cause of thumb pain is osteoarthritis, a degenerative condition caused by inflammation, breakdown and eventual loss of cartilage in the joints. The base of the thumb is a saddle joint, making the thumb the most mobile of all the fingers. But mobility has its consequences, primary among which is loss of function over time. Although there is no “fix” for osteoarthritis outside surgery, it is possible to significantly reduce pain and improve function when the disease is in its early stages.
Basal thumb arthritis is an osteoarthritic degeneration of the carpometacarpal joint at the base of the thumb. Prevalence tends to increase with age. Women are six times more likely to develop the condition than men. Other risk factors include diabetes, carpal tunnel syndrome, previous trauma (e.g. fracture), tenosynovitis of the wrist and trigger digits.
A X-ray of the thumb will typically show degeneration with increased laxity (looseness) in the area. From the outside the joint may appear swollen with a “swan neck” deformity (similar to a bunion on the big toe). Osteophytes or bony outgrowths may develop as the cartilage in the joint deteriorates.
You may feel stiffness in the joint, particularly first thing in the morning. Over time movement will become more difficult and you may experience decreased grip strength.
Few structures of the human anatomy are as unique as the hand. There are 27 bones that make up the wrist and hand. The wrist contains 8 small bones called carpals that join the two forearm bones, forming the wrist joint. The carpals connect to the metacarpals (there are five of them), which form the palm of the hand. One metacarpal connects to each finger and thumb.
The main knuckle joints are formed by the connection of the phalanges to the metacarpals. These joints are called MCP joints, and they work like a hinge when you bend and straighten your fingers and thumb.
Each finger is made up of three phalanges that are separated by two joints, the IP joints and PIP joints. The IP joints also work like hinges when you bend and straighten your fingers and thumb.
The thumb joint is unique and a special kind of joint. The shape of the trapezium looks like a horse's saddle with a rounded edge, which is why you have so much movement in your thumb. The saddle joint allows for the incredible thumb range motion and grip. Imagine how hard it would be to get through your day if your thumb only moved as much as your other fingers.
The joints of the hand, fingers, and thumb are covered on the ends with articular cartilage, a white, shiny material that has a rubbery consistency. It absorbs shock and provides a smooth surface to facilitate motion.
If you experience any of the following symptoms, it is time to contact your provider about thumb arthritis:
MRIs are advanced imaging to evaluate soft tissue injuries such as sprains and strains as muscles, tendons, and ligaments. It can also show accumulation of scar tissue in trigger finger or dupuytren's contracture.
After ruling out fractures and possible surgery, a physician may suggest conservative or home treatments depending on the severity of the hand pain.
Numbness and tingling in the fingers depends on the location of symptoms and severity. Numbness and tingling in the thumb, index, and middle fingers could be from carpal tunnel syndrome. While sensation changes in the little and ring finger could be an entrapment of the ulnar nerve at the cubital tunnel or tunnel of guyon. When the entire hand feels numb or weak it could be caused by compression of the neurovascular bundle, resulting in thoracic outlet syndrome or T.O.S.
A person who is diabetic could be experiencing diabetic neuropathy symptoms. Idiopathic neuropathy can develop in people who are not diabetic.
Thumb arthritis primarily affects post-menopausal women: the prevalence among members of this group is about six times higher than for men. Other risk factors include:
Putting less stress on the affected thumb joint by switching hands, using larger writing instruments and less forceful gripping may decrease your pain. You might also consider a hand splint that immobilizes the base of the thumb. A wrist stabilizer that leaves the thumb free to move can make the condition worse. If you can’t find a splint specific to the thumb, taping can help to support the area. You will need to tape or wear the splint for 3-4 weeks in order for it to be effective.
Your primary care physician may also recommend over-the-counter anti-inflammatories such as Advil, aspirin, Aleve, or Tylenol. Topical pain medications can temporarily alleviate hand pain. Most of these pain relievers come in the form of topical creams, gels, balms, patches, or sold over-the-counter. Certain topical medications require a physician's prescription.
If home treatments are ineffective, the next step is active treatments in which a physical therapist works to decrease inflammation and pain in the area as well as to strengthen the muscles around the joint. Your physical therapist may recommend splinting or taping, range of motion and strengthening exercises targeting the flexor and extensor muscles in the thumb, hand and wrist. Strengthening these muscles will decrease the stress on the joint, and compensate for laxity.
An occupational therapist can assist with ergonomic issues such as writing implements, eating utensils and assistive devices to make gripping objects and unscrewing jars easier.
Exercises to strengthen the thumb muscles can include using putty, a tennis ball or special hand grips. To strengthen the other four fingers, practice a Farmer’s carry using kettlebells. Wrist twisting exercises using a dumbbell while supporting the arm can also improve strength around the thumb joint.
Exercises to improve range of motion in the hand can include the thumb stretch, knuckle bend, fist stretch, thumb stabilization, fingertip touch and finger walk (see hand exercise page).
Although it is impossible to alter the structure of the damaged joint without surgery, Graston technique is an effective way to break up fascial adhesions and scar tissue in the area.
Graston technique utilizes stainless steel instruments designed to break down scar tissue by force. Sliding the tools along the skin pulls one layer of tissue against the next, breaking up adhesions. This triggers the body’s healing mechanisms to come in and repair the fibers. Graston technique can improve range of motion and consequently reduce pain and disability in the affected area.
Class IV laser or low level laser is a light therapy that is excellent for decreasing arthritic pain and inflammation. The laser acts to shut off production of inflammatory markers that trigger chronic pain and inflammation. At the same time, it turns on repair and healing processes inside the cells by speeding up the delivery of ATP (adenosine triphosphate). ATP acts as “fuel” for the cells to speed up healing of damaged tissue around the affected joint.
Many people who develop osteoarthritis in the basal thumb joint have weakness in the flexor and extensor tendons and muscles of the wrist and hand. Lack of grip and wrist strength exacerbates pain and puts additional stress on the joint itself. Hand and wrist weakness can lead to a variety of overuse and repetitive stress injuries, especially with the hand bent backwards.
Stretching and strengthening exercises are easy to do at home with minimal equipment. More information and examples can be found at hand and wrist strengthening exercises.
Many of our patients have felt much better after receiving acupuncture treatments for joint pain. Moderate and severe cases of rheumatoid and osteoarthritis have responded well to a series of acupuncture treatments. Read more on acupuncture.
Shockwave therapy utilizes a percussive instrument to decrease tightness in muscles and tendons of the palm and wrist, which can improve functionality. Improving the flexibility and function of the thumb muscles can improve grip strength, fine motor activities, and participation in recreational activities.
Your primary care provider may recommend a corticosteroid injection to decrease pain and inflammation in and around the joint. In some cases platelet rich plasma (prp) injections can be considered for relief.
Most physicians recommend conservative treatment for at least two months before considering surgery. If the disease has reached stage IV (marked restriction of activities of daily living despite continuous use of analgesics), has not responded to splinting, steroid injections or physical and occupational therapy, it is time to consider surgery.
At this point your primary care provider should refer you to a hand specialist.
If you are experiencing pain at the base of your thumb, seek treatment early on, to give yourself the best chance of symptom relief without surgery. An experienced provider can use a combination of conservative treatments and lifestyle modifications to reduce your pain and disability. Call Alpha Chiropractic today to address your thumb pain at (480) 812-1800.
Our Chandler Chiropractic and Physical Therapy clinic treats patients with a variety of muscle, tendon, joint and ligament injuries. The clinic provides treatment for endurance athletes and weekend warriors in addition to common headache, neck and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics.