Q: FOR THE PAST COUPLE OF MONTHS, MY THUMB HAS FELT ACHY, SWOLLEN AND STIFF. AS THE PAIN GETS WORSE, I’M WORRIED THAT I WILL BE FORCED TO GIVE UP KNITTING AND OTHER ACTIVITIES. WHAT ARE MY OPTIONS?

Pain in the thumb and the radial (thumbsided) aspect of the wrist is one of the most common problems I see. Some people have pain caused by a specific injury, or by a medical condition such as rheumatoid arthritis, gout or diabetes. But more often pain is caused by traumas so small you don’t realize they occurred—such as sleeping on your wrist or smacking into a doorframe—or by misuse (often mistakenly referred to as overuse).

You may have trigger thumb, one of the most common—and most treatable—forms of tendonitis (inflammation in a tendon). It’s possible the scissors you use for quilting irritated your tendon. Gardening or other tools, baseball bats, tennis rackets or anything people grip can be other common culprits.

I typically recommend people try activity modification. Take a break from activities that you know bother you, and avoid putting pressure on the sore area. As you start the day, try applying heat and loosening up your thumb and hand. Then apply ice packs and take over-the-counter non-steroidal antiinflammatory drugs (NSAIDs) throughout the day to help reduce pain and inflammation. (Commonly used NSAIDs are aspirin, ibuprofen and naproxen; check with your doctor before taking any new medications.) Try wearing a splint, especially at night, to keep the thumb straight while you sleep. If you still don’t find relief, call your doctor or an orthopedic specialist. In more advanced cases of trigger thumb, a cortisone steroid injection often helps. Surgery is also an option when conservative treatments fail.

Q: I’M A NEW MOTHER, AND PAIN AND WEAKNESS ON THE INSIDE OF BOTH WRISTS IS MAKING IT DIFFICULT TO PICK UP MY CHILD. IS THIS CARPAL TUNNEL SYNDROME?

You are more likely suffering from another common form of tendonitis: de Quervain’s. Swelling at the end of your pregnancy may have caused tendon rubbing, and now you’re probably trying to lift your baby, carry a car seat, swing around a packed diaper bag, etc. All of this can stress the tendons, and once aggravated, there’s very little chance to rest and recuperate.

When picking something up, try to lift with your wrists in a palm-up position instead of sideways or overhand. I’d also recommend trying the techniques listed above: splinting, taking NSAIDs and applying heat and cold packs. If you wear a splint, remove it several times a day; the goal is to keep the tendons gliding and loose so they don’t get adherent and stiff, but don’t overdo it. If these tactics don’t work, a cortisone injection and therapy may alleviate the problem, usually within three to four weeks. In cases where these conservative treatments haven’t worked, surgery is a final option.

Find information about Holland Hospital orthopedics.

ABOUT THE EXPERT
Richard Howell, MD
Orthopedic Hand and Microvascular Surgeon
Shoreline Orthopaedics & Sports Medicine
370 N. 120th Ave., Holland
(616) 396-5855

More information
To learn more about these and other painful hand conditions, see Dr. Howell’s presentation, Losing Your Grip? Causes and Treatments for Thumb Pain