Hand And Wrist Anatomy
The hand and wrist consist of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. From performing minor repetitive tasks to suddenly stopping the force of the body during a fall, the hands and wrists are susceptible to pain and injury at all stages in life.
- The hand consists of several small bones called phalanges, metacarpals, and carpals.
- The wrist is where the radius and the ulna meet at the hand.
- Between these bones is capsule, cartilage, and ligaments that allow for movement.
The carpal tunnel is an area where several tendons and nerves pass through the wrist. In carpal tunnel syndrome, these nerves and tendons are compressed.
Another common problem is pain at the base of the thumb, usually later in life, from arthritis. This is called basal joint arthritis and can be treated with splints, injections, and reconstructive surgery, if needed.
Other common problems include bone fractures, dislocations, and inflamed tendons and ligaments from overuse.
What Are The Symptoms
If you have the following symptoms, it doesn’t automatically mean you have De Quervain’s. But it is a distinct possibility. If you ever get these symptoms, go to your doctor as soon as possible. The sooner you get an official diagnosis, the sooner you can get started on some physio, which can improve things a great deal.
- Pain around the base of the affected thumb
- Inability to put your thumb up in an ‘OK’ gesture without severe pain
- Loss of grip in the affected hand
- Swelling around the base of the affected thumb
- A pinging feeling when you try to move the thumb . It’s a bit like how a person acting like a robot might move, only a lot more painful.
How Is De Quervains Disease Diagnosed
The diagnosis is clinical and the specialist relies mainly on the description of the symptoms, which are very characteristic.
The pain is associated with the execution of certain hand movements and this helps to differentiate the pain of De Quervains disease from the arthritic pain that is typical of awakening.
The Finkelstein test is also useful: the patient is asked to clench his thumb inside the other closed fist fingers and simultaneously bend his wrist in the direction of the little finger.
People with De Quervains syndrome find it difficult to move the thumb and bend the wrist due to pain.
In case of doubt, an ultrasound scan may be useful. This allows us to detect any inflammatory changes in the tendons and to observe their relationship to the walls of the canal in which they run.
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What Causes Pain In Wrist And Thumb
Pain in wrist and thumb often involves painful movements of the wrist, thumb and may also affect movements of other fingers. Holding or grasping of objects, fine motor skills may get affected due to wrist and thumb pain. Pain may sometimes be associated with numbness, burning sensation or a feeling of soreness in the area between the wrist and the thumb. Depending on the cause of the pain in wrist and thumb, there may be redness or swelling in a particular area or a noticeable bump may appear on the wrist, back of the palm, fingers or thumb.
Some of the common causes of pain in wrist and thumb include:
Pain in Wrist and Thumb Caused Due to Injuries Injury to the wrist joint, thumb or the hand can cause pain in and around the wrist and thumb, making hand and wrist movements difficult. Injuries often include trauma to the wrist joint, fracture, ligament or muscle strains and other soft tissue injuries around the wrist and thumb. Overuse injuries occur due to repeated trauma to the joint or tissues from repetitive motion, occurring again and again. It often causes pain, swelling, inflammation of the wrist, thumb and causes painful movements of the wrist, thumb and fingers.
Pain in Wrist and Thumb Caused Due to Tendinitis Tendons of the wrist and thumb can get inflamed due to injury, overuse or other problems and small tears may result causing pain. It may also affect the ability to hold objects and use wrist and thumb properly.
Can De Quervains Tendinosis Be Prevented
After treatment, de Quervains tendinosis can be prevented by changing the activities that cause pain. Taking breaks and avoiding the actions that cause pain, can help lessen the chance of the condition happening again after treatment. It is important to follow your doctors advice on what activities aggravate the condition and what you should avoid. Limiting these activities could prevent future issues with de Quervains tendinosis.
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Symptoms Of Wrist Pain
Wrist pain symptoms can vary depending on the cause. Some people may have pain that they describe as achy or dull, while others may have sharp pain. The location of the pain can also vary.
In addition to pain, other symptoms may develop. Symptoms of an injury, such as a wrist sprain, can include swelling and bruising.
Numbness, tingling, and hand weakness might also occur when pain is due to carpal tunnel syndrome.
Some people may develop the following symptoms:
- Stiffness: A person may feel this through their wrist and potentially in their fingers.
- Trouble gripping objects: Wrist pain may make grasping or holding on to objects difficult or uncomfortable.
- A clicking sound when moving the wrist: This can be more severe after periods of rest.
Depending on the cause, symptoms may be mild to start and worsen as time goes on.
At first, pain may only occur during certain activities. In time, as the condition worsens, the pain might occur even at rest. Numbness can also progress to the point where a person cannot feel cold or heat and may drop things.
What Is De Quervains Tendinosis
De Quervains tendinosis is a painful swelling of specific tendons of the thumb. The condition is also known as de Quervain tendinitis or de Quervains tenosynovitis. DeQuervains was named after the Swiss surgeon who first described the condition in 1895.
Tendons are bands of tissue that attach muscles to bones. Usually tendons slide easily through a tunnel of tissue called a sheath. The sheath keeps the tendons in place next to the bones of the thumb. Tendons that easily slide through their sheaths allow the thumb to move without difficulty or pain. The pain may extend from the forearm to the thumb base.
Any swelling of the tendons and/or thickening of the sheaths cause friction. The tendons can no longer easily slide through their sheaths. When this happens, certain thumb and wrist motions become more difficult to do.
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What Is The Finkelstein Test
One way to diagnose de Quervains is by performing a Finkelstein test. To do this, with your hand turned on its side, thumb side up, make a fist with your fingers wrapped around your thumb, and then move your fist downward toward your little finger. If this movement causes pain under the thumb, you may have this condition.
Surgical Treatment For De Quervains Tenosynovitis
Treatment for de Quervain syndrome begins with a noninvasive approach. Keeping the wrist and thumb immobile to allow the inflammation to heal is the first step. Taking over-the-counter anti-inflammatory medication like ibuprofen can also help keep symptoms under control. Steroid injections can be helpful when other treatments arent helping enough.
However, if the pain is persistent even after trying more conservative treatment methods, surgery may be recommended. During surgery, the restricted covering surrounding the tendons is released. This relieves pressure on the tendons to allow freedom of motion again. Without the constant friction, inflammation and pain through the tendons is able to heal.
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Physical Examination Of Wrist Popping And Pain Causes
Doctors examine the wrist to find the most tender spot. Also, special tests are helpful to confirm or rule out causes. For example, Watsons test is useful for a scapholunate ligament injury, and Finkelsteins test is used for De Quervains tenosynovitis.
In addition, examining the elbow, shoulder, and neck above the wrist is vital to exclude referred pain.
What Are Tendonitis And Tenosynovitis
Tendons are strong cords of tissue that connect muscles to bones. Tendonitis is when a tendon is inflamed. It can happen to any tendon in the body. When a tendon is inflamed, it can cause swelling, pain, and discomfort. Another problem called tenosynovitis is linked to tendonitis. This is the inflammation of the lining of the tendon sheath around a tendon. Usually, the sheath itself is inflamed, but both the sheath and the tendon can be inflamed at the same time.
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This Is The Characteristic Symptom Of De Quervains Disease A Pathology That Affects The First Finger Of The Hand: The Thumb
De Quervains disease is characterised by an inflammatory process in the sheath that covers two of the tendons that allow the thumb to move: the long abductor, which allows the thumb to move away from the other fingers, and the short extensor, which allows it to extend.
Inflammation results in swelling of the tissues around the tendons and a change in volume that prevents the tendons from flowing as they should within the canal that contains them.
My Diagnosis: De Quervain’s Tenosynovitis
I booked an appointment and went to see the doctor. She thought it was something I’d never heard of beforeDe Quervain’s tenosynovitis. Yep, it’s a mouthful .
She suggested I refer myself to the local hospital for physiotherapy . So I did that and waited a few weeks for an appointment. The diagnosis was confirmed through a few simple movements .
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Can Wrist Hand And Finger Pain Cause Problems Elsewhere
You may feel pain and stiffness in your forearm. This should improve as your problem gets better.
Sometimes you can experience altered sensation like pins and needles or numbness in your hand or fingers when the nerve is the irritated. If you have these symptoms speak to your GP.
Occasionally, problems felt in your wrist, hand or fingers can be due to a neck problem. This can happen even when you don’t feel pain in your neck. People with this sort of problem often describe the pain as pins and needles, sharp, hot or burning pain.
If you have any of these symptoms it would be helpful to read about neck problems.
Causes Symptoms And Treatment Options For Thumb Tendonitis
Patients with de Quervain syndrome have painful tendons on the thumb side of the wrist. Tendons are the ropes that the muscle uses to pull the bone. You can see them on the back of your hand when you straighten your fingers. In de Quervain syndrome, the tunnel where the tendons run narrows due to the thickening of the soft tissues that make up the tunnel. Hand and thumb motion cause pain, especially with forceful grasping or twisting.
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What Is The Treatment For Pain In Wrist And Thumb
Wrist and thumb are one of the most often used joints and can take time to heal if not given proper rest. In most causes of wrist and thumb pain, the treatment includes resting the wrist joint and the thumb, with a splint or a bandage, depending on the severity, for around 4 to 6 weeks or until it is healed.
Anti-inflammatory medications, pain relieving medicines, ointment and treatment to fight infections, arthritis or other conditions, depending on the cause may be given for wrist and thumb pain. Supplements of calcium, vitamin D and multi vitamins may be considered.
Physical therapy for pain in the wrist and thumb may include hot and cold compresses, wearing wrist and thumb braces for minor sprains, limiting and modifying activities to relieve pressure and reduce pain. Exercises to help strengthening of the supporting muscles may be advised by a trained physical therapist to improve functioning and flexibility of muscles and tissues.
Types Of Tendonitis And Tenosynovitis
Common types of these tendon problems include:
Lateral epicondylitis. This is most often known as tennis elbow. It causes pain in the backside of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist back and away from the palm.
Medial epicondylitis. This is most often known as golfer’s or baseball elbow. It causes pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.
Rotator cuff tendonitis. This is also known as biceps tendonitis. Its a shoulder disorder. It causes inflammation of the shoulder capsule and related tendons.
DeQuervain’s tenosynovitis. This is the most common type of tenosynovitis disorder. It causes swelling in the tendon sheath of the tendons of the thumb.
Trigger finger or trigger thumb. This is a type of tenosynovitis. The tendon sheath becomes inflamed and thickened. This makes it hard to extend or flex the finger or thumb. The finger or thumb may lock or “trigger” suddenly.
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Thumb Tendonitis Symptoms & Treatment
Thumb tendonitis causes pain in tendons around the base of the thumb, on the inside of the wrist and forearm. Some doctors call it De Quervains tendinosis. Both terms refer to inflammation along the thumb.
De Quervains affects the thumbs tendons cords of tissue that connect muscles and bones. When the tendons around the base of the thumb are irritated or constricted, they swell. This thumb swelling can cause pain, tenderness and weakness in the hand.
Sometimes people call De Quervains mommy thumb, because new mothers can strain their thumbs from lifting their newborns repeatedly. Just as often, people experience De Quervain syndrome after helping someone move on the weekend.
Treatment for De Quervains ranges from splints and steroids to minimally invasive surgery. At Aurora Health Care, we can help you find the right treatment option so you can get relief and get back to your life.
Pain Is The Main Symptom Of De Quervains Disease
Intense stabbing pain between the thumb and wrist is the hallmark symptom of De Quervains disease.
The pain may have a gradual or sudden onset and in some cases radiate to the forearm there may also be swelling in the wrist.
Repeated use of the hand and of the thumb in particular accentuates the pain, especially in movements requiring rotation of the wrist, such as opening a jar, or when grasping objects such as a bottle or a pot.
This is particularly true for those who make forced or repetitive movements with the wrist, such as: musicians those who embroider and sew a lot those who assiduously use the computer mouse, keyboard and mobile phone mothers who breastfeed, especially in the last period when the baby becomes heavy and supporting the head requires a great deal of effort from the tendons affected by this disease.
At the time of De Quervain, the Swiss surgeon who first described this disease, it was known as the disease of nannies and embroiderers.
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Common Causes Of Thumb Pain
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While this information can be useful to help narrow down what your thumb problem might be, it is strongly recommended that you consult with a health care professional before beginning any treatment. Treating your symptoms with the wrong diagnosis can not only delay proper healing, it may also make your condition worse.
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My Thumb Hurts Whats Wrong
Thumbs are awesome! So awesome in fact that most of the time we take them for granted. That is until your thumb starts to hurt. When you have thumb joint pain, you realize just how much you use it. Pain in your thumb can be caused by several health conditions. If you find yourself saying, my thumb hurts whats wrong, you may have one of the 4 common causes of thumb pain 1. CMC Thumb Arthritis, 2. de Quervains Tenosynovitis, 3. Gamekeepers or Skiers Thumb, or 4. Trigger Thumb.
Things You Can Do To Avoid Making The Pain Worse
Managing your pain is the best way to treat thumb and wrist pain and will help you recover quicker.
You should do things to try and ensure your pain does not get worse.
Things you could do are:
- change how you move your hand and wrist until symptoms begin to ease
- scoop your baby up with your sore hand under their bottom – this can be more comfortable
- keep your wrist rigid – this avoids pain irritation
- avoid wrist movements like opening the lid on a jar that is quite tight
- avoid using your thumb to grip objects
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