Thumb and wrist pain: A Neuromuscular Therapy point of view

Acute pain, Carpal tunnel syndrome (CTS), Chronic pain, Hand pain, Muscle information, Neuromuscular therapy, Repetitive strain injury (RSI), Thumb pain, Wrist pain / Wednesday, June 3rd, 2009

As a Boston area Neuromuscular Therapist, how do I think about thumb and wrist pain?

Thumb and wrist pain tends to come from an old injury or from overuse in an occupation, on a computer with a mouse, playing some musical instruments, or from writing, weeding, painting, crafting, or doing needlework that requires a pincer grip. Symptoms are sharp pain in the joint closest to the wrist with radiating pain into the wrist and often to the forearm. It usually hurts to open a jar or grasp anything tightly with your thumb and fingers.
We use our thumbs a lot and they are built to be used. After all, that’s what makes us different from animals, our opposable thumbs. The problems I see as a Neuromuscular Therapist are usually either from Trigger Points, muscle tension, tendonitis, or joint misalignment caused by one specific muscle. When someone complains of thumb pain I usually go to this last one first … and you can treat it yourself! Try it. (Look for the post on self-treatment.)

(Scroll to the bottom to see a drawing of the thumb muscles.)

1) Joint misalignment can be caused by the muscle I treat first, called the 1st dorsal interosseous. Muscle tension can pull the joint out of position at the base of your thumb (between the base of the first metacarpal and trapezium bones) and activate the nerves in the joint to tell you something is wrong. Releasing the tension in that muscle can realign the joint and release the pressure in the joint capsule ligaments and nerves that are causing the symptoms.

2) If local intrinsic muscle tension is causing pain, the second set of muscles I treat is in the fleshy part of your thumb called the thenar eminence.  There are four muscles that I group together as “short flexors” of the thumb. There is actually only one true flexor. The others are abductor, adductor and opponens pollicis. These four do all the complicated movements of our thumb.

3) Local inflammation of the tendons (tendonitis) of the extrinsic muscles of the thumb is another important cause of thumb and wrist pain. The long flexor, two extensors and one abductor are found in the forearm. Any of these four can cause wrist pain from inflammation of their tendons. Two of these tendons glide through a common tendon sheath. When the extensors and abductors of the thumb are too tight, they can pull on these tendons and cause friction in the tendon sheath as they rub on each other in their individual actions. Too much friction can cause inflammation. The inflammatory process causes the tendon to swell. It’s called deQuervain’s Syndrome or tenosynovitis. I’ve seen this condition so advanced that the skin over the tendon was covered with tiny red dots. The pain was excruciating. Treatment involves treating three muscles in the dorsal forearm and frequent icing of the tendon.


4) The final cause is, of course, Trigger Points, what we Neuromuscular Therapists are most interested in. Of the intrinsic muscles, the adductor and opponens pollicis are most important since they can also cause local muscle pain. Of the extrinsic muscles, the supinator, brachioradialis and brachialis are most significant. Pain can refer to the thumb from as far away as the scalene muscles in the neck and the subclavius muscles under the collarbone. Secondary trigger points come from the first muscle mentioned, the 1st dorsal interosseus, and from the long thumb flexor and pronator teres muscles.

So there’s a lot to think about and many places to examine in the search for the source of thumb pain.


11 Replies to “Thumb and wrist pain: A Neuromuscular Therapy point of view”

  1. I have sharp thumb pain which I believe is caused by some kind inflamation of the “Opponens Pollicis muscle”. I prsumed because whin I press that muscle, the pain feels deeper.
    Please advice me what I can do about it. As it is invisible, very unlikely to get a treatment elsewhere.
    Thanks and best regards,

  2. Hi Aaron,
    Sounds to me that you’ve either injured the joint which may take a bit to heal, or that you’ve strained the muscles that bring your thumb back away from your palm in the way you have described. The first stretch I give (for DeQuervain’s) in the Self-Treatment tips under Thumb and Wrist pain should help. I just added photos yesterday that should make it easier to understand. Go through the other stretches to correct the joint. If it’s been injured, balancing the muscles all around it will help relieve the pain.
    Thanks for reading my blog. Please pass the link on.

  3. Hi Candi,
    Sorry about the confusion. It sounds as if you were in the blog and didn’t discover the search box or category menu. Go to the sidebar on the right and just under the photo at the top you will find the Search box. You can enter a search term like Thumb pain there. Alternatively you can go the the Category box just under the Search box. If you click on it, you’ll see a drop-down menu and can choose a subject and click on it. A search will take place that will bring up any post I’ve written that relates to that category. When the list comes up, click on the title of the post you’re interested in reading. Note that at the bottom of the list, you may also see “Older entries.” Clicking on that will give you more post titles if they don’t all fit on the first page. Hope that helps. Thanks for reading!

  4. Christina!!!! You are a life saver!! I’m 23yrs old, and dealing with wrist tendonitis. I was looking for wrist tendon strengthening guides but came across this page. I had NO idea my mysterious thumb pain had any relation with the wrist pain! (Right?? Lol)

    The pain in my thumb is located on top of it, and hurts when I grip objects.

    By following this guide tonight, everything feels fantastic.

    However the only question I DO have is – is this enough to “cure” my wrist tendonitis and thumb pain? As of now, I’m following the guide in the link, resting from wrist use activity, icing, and wearing a splint.

    Thanks again, this site is fantastic.


    1. HI Ashton, Glad the information helped! You’re going to have to keep after it. Stretch and treat the muscles in the thumb web, the fleshy base of your thumb, and the muscles in your forearm above your wrist regularly, focusing on places that hurt. Overuse requires lots of self care to keep injury from recurring. Watch the splint use. It tends to cut off blood and prevent good movements if it’s too tight or worn too much. Stay well!

  5. Hi Erva, Since you posted this comment a month ago I’ve been writing a lot more about arm and hand pain. This January series covers a lot of things to think about. When you start getting pain at your age, it’s important to take very good care of yourself in order to keep doing what you love. My suggestion is a short daily routine of stretching your neck, chest and shoulder muscles. Previous blog posts cover those. Then add stretches for your forearm and some focus work on the muscles that are most troublesome. I’ll be including self-treatment tips using a “Knobble” within the next few weeks, so look for those. If you can afford a few Neuromuscular Therapy or deep tissue treatments on your forearms and hands, that would help a lot.

  6. Hi – I just had carpal tunnel surgery about 1 week ago today – during the weekend I’m not sure if i slept on it funny or pulled a muscle but my muscle to my thumb is crazy sore – and a pinching feeling when moving. I’m embarrassed to call the dr because i’m not sure what part of the hand it’s called. What do you call the fatty part below the thumb?

    1. Hi Katie,
      It’s called the “thenar eminence.”
      Let me know if his advice doesn’t clear up your pain. I may be able to help.
      Best regards, Christina

  7. Hello! Was hoping you could help me identify the “part” that’s causing me pain, when I grip tightly. Can’t seem to find a reference to it anywhere… it’s in what I think is a tendon, that’s connected between my thumb MCP and index finger MCP.
    It doesn’t originate on either end in the wrist. Assuming it extends into my index finger on that end- best I can tell it’s involved in index finger flexion. To be sure, the pain isn’t in my thumb- it’s in this “tendon”, and when enough pressure is on it, such as when lifting weights and gripping a bar tightly, I’ll get nerve pains that will radiate through my hand and forearm as well, and it will fell like the tendon is about to snap.

    Any ideas on this one? Thanks!!!

  8. Christina, thank you for the most informative guide to assist with a thumb sprain. After 6 mos. if pain in my left thumb, I just followed your message guide and in the timeframe of about 10 minutes of intense massaging and following your pictorial guide the tightness and limited mobility finally are gone! I can actually touch my pinkie with my thumb which 5 minutes ago I barely reached the third finger. The intense sharp pain is but a strong soreness. Unbelievable! Thank you, thank you, thank you!!!

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