Pain in the ball of the thumb
introduction
In the ball of the thumb there are a few short muscles of the ball of the thumb which, although they cannot generate a lot of force, are necessary for many movements to move the thumb at all.
In addition to these muscles, the ball of the thumb also contains the important thumb saddle joint, which is essential for the various movements of the thumb. If osteoarthritis develops in the thumb saddle joint in the course of life, this can also lead to pain in the ball of the thumb.
The reasons
The causes of pain in the ball of the thumb are very diverse and mostly of a harmless nature. Diseases of the tendons, muscles, nerves or bones are responsible for pain in the ball of the thumb.
In many cases, incorrect loads or excessive loads are the cause. In addition, injuries, accidents and autoimmune diseases associated with joint inflammation, such as rheumatism, can damage muscles, tendons, nerves or bones.
As different as the causes of pain in the ball of the thumb are, so are the accompanying symptoms, which can provide an indication of the underlying disease.
Read more on the subject here: Rheumatism.
The fall as the cause
After a fall in which the affected person catches himself with his hand with his thumb stuck out, the ligaments can suddenly become overstretched or even tear. In addition, a bony tear of the ligament can occur.
This injury process is also known as the skier's thumb, as the collateral ligament of the thumb is often injured during skiing. The thumb joint usually swells up a lot, grasping movements are almost impossible, and moving the thumb is very painful.
If the ball of the thumb swells after a fall, a doctor should be consulted to identify and treat severe injuries or injuries that require treatment.
More information on the topic Ski thumb you'll find here.
Osteoarthritis as the cause
So-called rhizarthrosis is degenerative wear and tear of the joint in the thumb saddle joint, which is located in the ball of the thumb. This joint allows for many movements such as rotating the entire thumb and facing the thumb with the other fingers, which is known as opposition. Rhizarthrosis is relatively common, especially in women. Ten percent of women over 50 are affected, while men are affected less often.
Often the rhizarthrosis occurs at the same time on the opposite side or other finger joints are affected by osteoarthritis. Since the thumb saddle joint arthrosis progresses slowly, this is also reflected in the symptoms. Stress-dependent pain usually occurs in the area of the lower thumb saddle joint and in the area of the extensor side of the thumb saddle joint.
If the disease progresses, the pain increases and the strength decreases. This is often expressed in everyday activities that are difficult to carry out with pain, such as opening a bottle or screw-cap jars. Many patients also suddenly lose objects. Pain in the ball of the thumb also occurs at rest and at night. The spreading of the thumb and rotations can also only be carried out to a limited extent.
If the osteoarthritis progresses, bony changes can even make it completely impossible to spread the thumb, which leads to an overstretching of the metatarsophalangeal joint.
If the doctor examines the ball of the thumb, he can provoke significant pressure pain over the thumb saddle joint in the case of a rhizarthrosis. The doctor can often also detect painful crepitations (audible and tangible crackling noises) over the joint.
Find out all about the topic here: Thumb saddle joint osteoarthritis.
The carpal tunnel syndrome as the cause
In carpal tunnel syndrome, a nerve - the median nerve - that pulls over the forearm into the hand is permanently narrowed. At the transition from the forearm to the hand there is a ring-shaped retaining strap that covers the finger tendons, among other things, but constricts the nerves in carpal tunnel syndrome.
Initially, there is pain in the index and middle finger and thumb. In the further course, the muscles of the ball of the thumb shrink. The syndrome is often caused by excessive stress. However, this disease can also occur without an apparent cause or in the context of a joint inflammation.
Therapy should start early with immobilization and pain therapy. The tether that constricts the nerve often has to be surgically split.
Read more about the topic here: The carpal tunnel syndrome.
The cause of gout
Gout is a so-called affluence disease as it occurs particularly in people who consume a lot of alcohol and meat. If the uric acid level in the blood is high (so-called hyperuricemia), the uric acid is deposited in the joints in the form of salt crystals and causes symptoms. Although the metatarsophalangeal joint of the big toe is often affected in gout, the inflammation can also take place in the metacarpal joint of the thumb.
An acute gout attack leads to joint inflammation and pain in the ball of the thumb, even at rest. In addition, there may be swelling and reddening of the ball of the thumb.
Pain relievers, so-called NSAIDs (non-steroidal anti-inflammatory drugs), are administered to relieve the pain and inflammation. In order to prevent another attack of gout, the drug allopurinol is prescribed for steady intake and for lowering uric acid in the blood.
Find out all about the topic here: Gout.
The quick thumb as the cause
The quick thumb is also known as stenoscopic tendovaginitis, whereby inflammation leads to a knotty thickening of the flexor tendon with temporary entrapment.
The tendons of the thumb and the rest of the fingers are connected to the bone by what are known as ring ligaments. When the thumb is flexed and stretched, the tendon slides in the ring ligament. The name of the quick thumb comes from the fact that the thickened flexor tendon makes it difficult to overcome the ring ligament when gliding. Once the resistance has been overcome, the thumb snaps or snaps into the desired position. The flexion and extension is very painful as it progresses.
A splitting of the ring ligament is a possible therapy.
You can read more about this topic here: The quick thumb.
The ski thumb as the cause
The collateral ligament of the skier's thumb tears after a fall with the thumb extended. Pressure pain over the ball of the thumb and instability develop.
If the ligament is only partially torn, the thumb is immobilized and drug therapy with pain medication takes place. However, if the ligament is completely torn, an operation must be performed to fix the collateral ligament again.
Find out more about the topic here: The skier's thumb.
The symptoms
In addition to the pain, there is often swelling of the ball of the thumb. This can also be reddened and overheated. In addition, there is a restriction in movement of the thumb. This can be due to pain, torn ligaments and the resulting instability.
In the case of carpal tunnel syndrome, there may also be sensory disorders with numbness and tingling sensations in the thumb, index and middle fingers. If the thumb is trauma, a bruise (known as a hematoma) can also occur.
The swelling as a symptom
Swelling can be caused by inflammation in the joint. The accompanying swelling is typical, for example, in gout or rheumatism. Even after injuries, torn ligaments or broken bones, the ball of the thumb usually swells.
Pain when grasping
If there is pain when grasping, opening the bottle or turning a key, this is usually a sign of osteoarthritis in the thumb saddle joint.
Furthermore, the so-called tendovaginitis stenosans de Quervain causes pain in the thumb, especially when grasping movements. It is an inflammation of the tendon sheaths of two muscles of the thumb. Women after the menopause are particularly affected. In addition to the pain when grasping, there is also tenderness in the area of the lateral wrist, where the tendons attach. If the thumb is pressed towards the palm of the hand, pain occurs (so-called Finkelstein sign) and speaks for this tendinitis.
The therapy is first carried out non-surgically by immobilization. If this is not successful, an operation that splits the tendon sheath is usually performed.
Find out all about the topic here: De Quervain's stenoscopic tendovaginitis.
Pain when splaying
Most of the time, pain in the ball of the thumb occurs at the same time as a so-called adducted thumb position. The thumb is adducted when it is drawn towards the palm and can no longer be spread outwards. In this state, the muscles that are responsible for adduction are in permanent contraction and can be felt hard.
In addition to the adductors, other muscles can also be affected. If there is pain in the ball of the thumb and the thumb can no longer be spread, this is often due to repetitive activities that are carried out with the thumb / hand. These often include intensive use of the computer mouse, braking with the thumb when riding a bicycle and handicrafts such as knitting, where the thumb has to apply greater pressure.
The diagnosis
In order to find the cause of the pain in the ball of the thumb, the doctor first conducts a questionnaire (so-called anamnesis). For example, when, how often or under what circumstances the pain occurs. If the pain occurs after a fall, it is important to describe the exact course of the accident. This is followed by a physical examination, whereby the thumb is palpated and the range of motion of the thumb is tested.
If a bone fracture is suspected, an X-ray will be requested. Torn tendons and ligaments are best assessed using MRI. The attending physician will decide which exact examination method is used.
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The treatment
Treatment depends on the underlying cause. In general, pain can be treated with NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). In addition, NSAIDs also have anti-inflammatory effects. This can reduce both inflammation and pain. Cooling the thumb is recommended to prevent swelling.
There are various treatment options available for osteoarthritis of the thumb saddle joint. Before thinking about an operation, there is the option of non-surgical treatment at the beginning of the disease. This can be done using a plaster splint or orthosis (Rhizoloc splint) happen so that the thumb saddle joint is then immobilized for a short time and can recover during this period. Occupational therapy can also be helpful. Hyaluronic acid injections are often carried out under X-ray control to replace a little of the damaged cartilage. However, this therapy does not work in all patients. Some doctors attribute no effect at all to this therapy.
If the discomfort increases or the functionality is too limited, an operation is performed.
Gout is treated with the drug allopurinol, which lowers uric acid in the blood. Temporary immobilization of the thumb is also useful. Often an operation has to be carried out in which, for example, ligaments are reattached or, as in the case of carpal tunnel syndrome, the tether on the wrist is split.
Find out more about the topic here: Surgery for a thumb saddle joint osteoarthritis.
The bandage
A bandage is useful if the thumb joint is to be immobilized. It is particularly useful if the pain in the thumb is caused by overexertion, so that relief can be achieved.
Even when attempting conservative, i.e. non-surgical, treatment of the carpal tunnel syndrome, the movement of the hand or thumb should be restricted by a bandage.
The duration
The duration of the pain in the ball of the thumb depends on the underlying condition. In the event of an injury to the tendons, ligaments or bones, a duration of several weeks to months can be expected.
The symptoms of gout, especially if alcohol and meat consumption are not restricted, can recur and in the course of time lead to destruction of the joint with permanent pain. Osteoarthritis also usually causes permanent problems and the pain can usually only be limited in intensity.
