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Cause

De Quervain’s tendinosis occurs when the tendons around the base of the thumb are irritated, which will be very noticeable when forming a fist, grasping, gripping or even turning the wrist. De Quervain’s is the result of overuse.

Who’s Likely to Get It

De Quervain’s tendinosis is often associated with pregnancy and rheumatoid disease. It’s most common in middle-aged women.

Symptoms

The main symptom is pain over the thumb side of the wrist, which will likely be worse when the hand and thumb are being frequently used. Swelling may be seen over the thumb side of the wrist, and there may be fluid-filled cysts in this region. A “catching” or “snapping” sensation may also be felt when moving the thumb. Associated pain can be gradual or sudden, and it can be felt in the wrist, or even travel up the forearm.

Treatments

The goal of treatment is to relieve pain caused by irritation and swelling. Nonsurgical options include:

• Splints, to rest the thumb and wrist
• Anti-inflammatory medication, to help reduce swelling and relieve pain
• Rest, which may allow symptoms to go away on their own
• Corticosteroids, which may help reduce swelling and pain

Surgery may be recommended if symptoms are severe or do not improve with nonsurgical treatment. The goal of surgery is to open the thumb compartment to make more room for the irritated tendons.

Causes

A deep cut on the palm side of the finger, hand, wrist or forearm can damage the flexor tendons (the tissues that help control movement in your hand), which can make it impossible to bend the fingers or the thumb. Sports injuries can sometimes have the same effect. For example, “jersey finger” is common in football, wrestling and rugby – an injury where a player’s finger gets stuck in another player’s jersey, resulting in a pulled or strained digit because the tendon got pulled from the bone. Other conditions, such as rheumatoid arthritis, can weaken the flexor tendon – making it more likely to tear. However, this can happen without injury or symptoms, as a patient may suddenly realize that a finger no longer bends.

Symptoms

Common symptoms for flexor tendon injuries can include:

• Open wounds, such as a cut on the palm side of the hand, often where the skin folds at the bend in the finger
• Inability to bend one or more joints of the finger
• Pain when the finger is bent
• Tenderness along the finger on the palm side of the hand
• Numbness in the fingertip

Treatments

A doctor may place the hand in a splint to protect it while it heals. But, in most cases, a torn tendon must be repaired surgically. There are several different procedures to repair a torn tendon, depending on the nature of the tear. Tears can be straight across, torn at an angle and/or pulled from the bone. Each specialized surgical procedure includes special sutures/stitches, and recovery improves when surgery is performed soon after the injury.

Cause

Joints use articular cartilage in between bones to move smoothly. Arthritis occurs when the cartilage decreases – gradually causing pain and inflammation in the joints.

Types

There are various types of arthritis, including:

• Osteoarthritis: This condition is also referred to as “wear-and-tear arthritis,” as it causes cartilage to wear away. It generally affects older people.
• Rheumatoid arthritis: This is a chronic disease that can affect many joints – causing the synovium, joint and the lining of the joint to swell, which results in pain and stiffness. Typically, it starts in smaller joints, like the hand or foot. Rheumatoid arthritis is also a symmetrical condition, meaning it usually affects the same joints on both sides of the body.
• Fractures and dislocations: Injuries that damage the joint surface can also lead to arthritis. Even when properly treated, an injured joint is more likely to become arthritic over time.

Symptoms

Hand arthritis can cause:

• Pain: An early symptom includes pain after activities involving the affected joint. Pain may start hours after activity or even the next day.
• Swelling: As a result of increased use, the joint may swell to prevent further damage.
• Warmth: The affected joint may feel warm to touch due to the inflammation.

Treatments

There are numerous nonsurgical treatment options for hand and wrist arthritis. Your personalized plan will be based on how far the arthritis has progressed, the number of joints involved, if the dominant or non-dominant hand is affected, plus your age, activity level, personal goals, other medical conditions, home support structure, and your ability to understand the treatment and comply with a therapy program. Options include:

• Medication: Medication treats symptoms, but it does not restore joint cartilage or reverse joint damage. The most common medications for arthritis are anti-inflammatories, which stop the joints from swelling and reduce pain. Medications such as acetaminophen and ibuprofen are the most common.
• Injections: Injections are used when anti-inflammatory medication is appropriate. Injections typically contain a long-lasting anesthetic and a steroid that can provide pain relief for weeks to months. They can be repeated, but only a limited number of times due to possible side effects, such as lightening of the skin, weakening of the tendons and ligaments, and infection.
• Splinting: Injections and splinting are used together on the affected joint. The splint supports the affected joint to ease the stress placed on it from frequent use and activities. Splints are typically worn during periods when the joints hurt. They should be small enough to allow functional use of the hand when they are worn, and it should be noted that wearing the splint for too long can lead to muscle deterioration.

When nonsurgical treatment fails to improve the condition, surgery is usually discussed. There are several surgical options, but the goal will always be long-term pain relief and the return of function. Thus, treatment will be tailored to your individual goals and needs.

If the joint can be preserved or reconstructed, this is the preferred option. When the damage has progressed to a point that the surfaces will no longer work, a joint replacement or a fusion is performed.

Cause

A sprained thumb occurs when the ligaments supporting the thumb stretch or tear – often occurring when the thumb is bent backward, away from the hand. The most common injury resulting in a sprained thumb is falling.

Who’s Likely to Get It

Sprained thumbs are also referred to as “skier’s thumb,” as this condition is common among skiers. They’re also common in sports that involve throwing or catching.

Stages

Like other sprains, a thumb sprain is graded:

• Grade 1: Ligaments are stretched, but not torn, and the pain is mild.
• Grade 2: Ligaments are partially torn and there is some loss of function. Pain is moderate.
• Grade 3: Ligament is completely torn and removed from the bone. Pain is severe and the condition often requires surgical care.

Symptoms

Common symptoms include bruising, tenderness and swelling around the base of the thumb, but it’s dependent on the severity or grade of the sprain. Pain may not occur immediately after the injury.

Treatments

Treatment is dependent on the severity of the sprain. Mild sprains often improve with home remedies, such as the RICE protocol:

• Rest: Refrain from using the injured area for 48 hours.
• Ice: To reduce swelling, apply ice to the injured area immediately. 
• Compression: Wear a compression band to help to reduce swelling.
• Elevation: Raise the hand above the heart as often as possible.

Non-steroidal and anti-inflammatory drugs, such as ibuprofen or aspirin, can also help reduce swelling and pain. Additionally, mild sprains can be treated by immobilizing the hand using bandages, splints or a cast. It’s critical to refrain from applying pressure to the sprain before it heals. 

For a severe thumb sprain, surgery may be needed to restore the stability of the thumb joint and help regain function. The surgery will reconnect the ligament to the bone and/or repair the avulsion fracture using a pin, screw or special bone anchor. Afterward, the patient may be required to wear a short arm cast or a splint for six to 12 weeks to protect the ligament while it heals.