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.