What are the causes of thumb pain?

From the Guidelines

Thumb pain is most commonly caused by osteoarthritis, particularly at the thumb base.

Causes of Thumb Pain

• Osteoarthritis (OA) is a major cause of thumb pain, especially at the thumb base 1
• Risk factors for hand OA, including thumb pain, include female sex, increasing age over 40, menopausal status, family history, obesity, higher bone density, greater forearm muscle strength, joint laxity, prior hand injury, and occupation or recreation-related usage 1
• Typical symptoms of hand OA, including thumb pain, are pain on usage and only mild morning or inactivity stiffness affecting just one or a few joints at any one time 1
• Other potential causes of thumb pain include psoriatic arthritis, rheumatoid arthritis, gout, and haemochromatosis, although these are less common 1

Diagnosis and Management

• Diagnosis of thumb OA is typically made clinically, with plain radiographs providing the gold standard for morphological assessment 1
• Management of thumb OA includes education and training in ergonomic principles, exercises to improve function and muscle strength, orthoses, topical treatments, and oral analgesics 1
• Intra-articular injections of glucocorticoids may be considered in patients with painful interphalangeal joints, but are not generally recommended for thumb base OA 1
• Surgery, such as trapeziectomy, may be considered for patients with structural abnormalities and persistent pain despite other treatments 1

From the Research

Causes of Thumb Pain

The causes of thumb pain can be varied and complex. Some of the possible causes include:

• Carpal tunnel syndrome, which is caused by pressure on the median nerve as it travels through the carpal tunnel 2
• Basal joint arthritis of the thumb, which is a common condition, especially in women, and can be quite disabling 3
• Traumatic causes, such as minor injuries, which can require conservative management, including immobilization followed by exercise 4
• Infectious causes, such as cellulitis, tendinitis, paronychia, felon, and infectious emboli, which generally require antibiotics with or without drainage 4
• Vascular and ischemic causes, which represent true emergencies, because tissue viability is dependent on prompt intervention 4
• Systemic rheumatic disease, such as rheumatoid arthritis or vasculitis, which may begin with finger pain 4
• Reflex sympathetic dystrophy, which is an example of referred pain, presumably by way of neural mechanisms 4
• Thumb carpometacarpal (CMC-I) osteoarthritis (rhizarthrosis), de Quervain's stenosing tenosynovitis, carpal tunnel syndrome, and Wartenberg's syndrome, which are all possible differential diagnoses for pain around the first ray of the hand 5
• Bone alterations, such as bone cysts, which can be detected by MRI and may reflect the pathophysiology of osteoarthritis with thumb carpometacarpal joint pain 6

Diagnostic Considerations

Diagnosing the cause of thumb pain often requires a detailed medical history, targeted clinical examination, and the use of modern imaging techniques, such as MRI 5, 6. Radiographs can also be used to stage the severity of arthritis 3.

Treatment Options

Treatment options for thumb pain can range from conservative measures, such as splinting and exercise, to surgical interventions, depending on the severity and underlying cause of the disease 3, 5.