From the Guidelines
A thorough workup for shooting pain in both thumbs should begin with a detailed medical history and physical examination by a healthcare provider, focusing on assessing the location, duration, and triggers of the pain, as well as any associated symptoms like numbness, tingling, or weakness, as recommended by the 2018 update of the EULAR recommendations for the management of hand osteoarthritis 1. The physician will likely assess the range of motion, strength, and sensation in both thumbs. Diagnostic tests may include X-rays to check for arthritis or fractures, nerve conduction studies to evaluate for carpal tunnel syndrome or other nerve compression, and blood tests to rule out inflammatory conditions like rheumatoid arthritis. An MRI might be ordered if soft tissue damage is suspected. Common causes of bilateral thumb pain include:
- Osteoarthritis (particularly at the base of the thumb)
- De Quervain's tenosynovitis
- Carpal tunnel syndrome
- Rheumatoid arthritis Treatment will depend on the specific diagnosis but may include:
- Rest
- Splinting
- Anti-inflammatory medications like ibuprofen (400-800mg three times daily with food)
- Corticosteroid injections
- Physical therapy
- In severe cases, surgical intervention, as suggested by the EULAR recommendations 1. Early diagnosis is important as some conditions can worsen if left untreated, potentially leading to permanent damage to joints or nerves in the affected area. The use of orthoses should be considered for symptom relief in patients with thumb base OA, with long-term use advocated, as stated in the 2018 update of the EULAR recommendations 1. It is essential to pay attention to prescribing a well-fitted orthosis, preferably custom-made by a specialized health professional, to improve patients' compliance and increase long-term use. The EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis suggest that typical symptoms of HOA are pain on usage and only mild morning or inactivity stiffness affecting just one or a few joints at any one time, and that a confident clinical diagnosis can be made in adults aged over 40 1.
From the Research
Possible Causes of Shooting Pain in Both Thumbs
- Shooting pain in both thumbs can be caused by various conditions, including carpal tunnel syndrome, thumb carpometacarpal (CMC-I) osteoarthritis, de Quervain's stenosing tenosynovitis, and Wartenberg's syndrome 2
- Carpal tunnel syndrome is a common condition that can cause pain, numbness, and tingling in the hands and wrists, particularly in the thumb area 3, 4, 5
Diagnostic Approaches
- A detailed medical history, targeted clinical examination, and modern imaging techniques are crucial for making a diagnosis 2
- Nerve conduction studies and electromyography can be used to quantify and stratify disease severity 5
Treatment Options
- Conservative treatment options include lifestyle modifications, such as decreasing repetitive activity and using ergonomic devices, although the evidence for their effectiveness is inconsistent 5
- First-line therapies for carpal tunnel syndrome include cock-up and neutral wrist splints and oral corticosteroids, with local corticosteroid injections used for refractory symptoms 3, 4, 5
- Surgical evaluation should be considered for patients with moderate to severe disease 5
- Local corticosteroid injection and anti-inflammatory medication can be effective treatment options for carpal tunnel syndrome, although the benefits may not be maintained in the long term 3, 4