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Pain around the base of the thumb
Pain around the base of the thumb or on the thumb side of the wrist is common and can happen for a number of reasons. The two most common causes are De Quervain tenosynovitis and wear-and-tear arthritis at the base joint of the thumb. Although these conditions can cause similar symptoms, they affect different structures and may require different treatment.
1. De Quervain Tenosynovitis
What is it?
De Quervain tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. These tendons pass through a tight tunnel, and when the tendon lining becomes irritated or swollen, movement of the thumb and wrist can become painful.
Symptoms
The main symptom is pain around the base of the thumb or along the side of the wrist. The pain is often worse with gripping, lifting, twisting, pinching, or moving the thumb. There may also be tenderness or slight swelling in the area. These symptoms can make everyday activities such as opening jars, lifting objects, or carrying bags uncomfortable and difficult.
Diagnosis
Diagnosis is usually made clinically from your history and examination. A simple clinical test is often enough to confirm the condition. In some cases, an ultrasound scan or MRI scan may be requested if the diagnosis is not completely clear or if another problem is suspected.
Treatment
Treatment for De Quervain tenosynovitis usually starts with conservative treatment, which may include rest, activity modification, pain relief, physiotherapy, and the use of a splint. A steroid injection can also be offered to help settle the inflammation and pain. When symptoms continue despite these measures, the most reliable and long-lasting treatment is open release of De Quervain tenosynovitis. This is usually performed under local anaesthetic as a day-case procedure, meaning you can normally go home the same day. The operation has a high success rate, with published evidence suggesting improvement in around 90–95% of patients. Recovery is usually straightforward, with downtime of around a couple of weeks for lighter activities, although heavier work may take a little longer.
2. Arthritis of the Base of the Thumb
What is it?
Arthritis at the base of the thumb is osteoarthritis of the carpometacarpal joint (CMCJ). This is a common wear-and-tear condition affecting the joint between the thumb metacarpal and the trapezium bone. It becomes more common with age and can gradually lead to pain, stiffness, and weakness around the base of the thumb.
Symptoms
Typical symptoms include pain and stiffness at the base of the thumb, tenderness over the joint, and difficulty with gripping or pinching activities such as opening jars, turning keys, fastening buttons, or lifting objects. As the condition progresses, it can affect the strength and function of the hand in everyday activities.
Diagnosis
Diagnosis is mainly based on the symptoms and clinical examination. X-rays are commonly used to confirm the diagnosis and assess the degree of arthritis. Occasionally, a CT scan may be helpful when further detail is needed.
Treatment
Treatment usually starts with conservative treatment, including activity modification, pain relief, physiotherapy or hand therapy, exercises, and splintage. A steroid injection into the joint may also help to reduce pain. If symptoms remain troublesome, surgery may be considered. The most common operation is removal of the worn-out bone at the base of the thumb, called the trapezium. This operation is usually performed under general anaesthetic and can often be done as a day-case procedure. This operation has a high success rate and is generally associated with minimal complications. Recovery usually takes a few weeks, although improvement in comfort and function can continue for longer.
Mr Ayoub will be able to provide you with further details and recommend the most appropriate treatment for your particular case during your consultation. Back...
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