I'm experiencing locking, popping, and pain in both thumbs, what could be causing these symptoms and how can I get treated?

Bilateral Thumb Locking and Popping with Pain

You most likely have trigger thumb (stenosing tenosynovitis), and your first-line treatment should be a corticosteroid injection combined with thumb immobilization using a splint. 1

Understanding Your Symptoms

Your constellation of symptoms—locking, popping, and localized tenderness—is characteristic of trigger finger affecting both thumbs. 1 This condition involves abnormal resistance to smooth flexion and extension ("triggering") of the affected digit and is surprisingly common, affecting up to 20% of adults with diabetes and approximately 2% of the general population. 1

The "locking up" you describe occurs when inflamed flexor tendons catch on the pulley system in your thumb, creating the characteristic triggering sensation. 1

Diagnostic Approach

Your diagnosis is primarily clinical, based on:

• Palpable tenderness localized to the A1 pulley at the base of your thumb (where the thumb meets the palm) 2
• Reproducible triggering with active thumb flexion and extension 1
• Pain that is "sharp" or "stabbing" in quality 2

No imaging is typically required for trigger thumb diagnosis, as this is a clinical diagnosis made by history and physical examination. 1

Treatment Algorithm

First-Line Treatment (Start Here)

Corticosteroid injection is your most effective initial treatment, relieving symptoms in approximately 72% of patients, particularly when combined with immobilization. 1

• The injection should be administered into the flexor tendon sheath at the A1 pulley level 1
• Combine with thumb spica splinting to immobilize the affected thumbs 1
• Important caveat: If you have diabetes, especially insulin-dependent diabetes, steroid injections are less efficacious, and you may benefit from earlier consideration of surgical release 1

Alternative Conservative Options

If you prefer to avoid injections initially or have contraindications:

• Splinting alone can be attempted, though less effective than injection plus splinting 1
• NSAIDs (such as ibuprofen) for short-term pain relief, though they have no effect on long-term outcomes 2
• Topical NSAIDs (such as diclofenac gel) are effective with fewer systemic side effects 2, 3

When Conservative Treatment Fails

Surgical release should be considered if:

• Symptoms recur after initial steroid injection 1
• You have diabetes (particularly insulin-dependent), as you may benefit from early surgical release 1
• Conservative treatments fail after 3-6 months 2

Surgery for trigger thumb involves releasing the A1 pulley and is safe and effective for patients unresponsive to conservative therapy. 1

Important Considerations

Bilateral involvement (both thumbs affected) should prompt consideration of:

• Underlying diabetes screening if not already diagnosed 1
• Evaluation for rheumatic disease if multiple digits are involved beyond just the thumbs 2

Activity modification is crucial—reduce repetitive gripping and grasping activities that load the flexor tendons repetitively. 2

What to Avoid

• Do not delay treatment, as chronic triggering can lead to permanent stiffness 1
• Avoid proceeding directly to surgery without attempting at least one corticosteroid injection, as most patients respond to conservative management 1
• Do not confuse this with thumb carpometacarpal (CMC) arthritis, which presents with pain at the thumb base during pinching activities rather than triggering with flexion/extension 1, 4