Thumb Osteoarthritis

Pathophysiology

The thumb joint articulates with the trapezium which is one of the small carpal bones in the hand. This is the most commonly affected joint in the hand with osteoarthritis. More common in women than men with 30% of women aged over 40 years showing arthritic changes on x-ray. May exist as a localised (single joint) or type of inflammatory arthritis e.g rheumatoid arthritis/gout and previous injuries may increase risk.

Symptoms

  • Pain with repetitive movements e.g pinching, turning and clicking of finger to thumb
  • Swelling and tenderness at the base of thumb
  • Loss of strength when gripping or pinching
  • Reduced range of movement of the thumb
  • Development of a bony prominence over the thumb

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including range of movement, strengthening exercises and splinting
  • Orthopaedic options includes steroid injection and surgery if symptoms are not settling with 3 months conservative measures

Investigations

  • X-ray can assess the level of osteoarthritis

Exercises to try:

Isometric Thumb Extension

Isometric Thumb Extension

With your thumb facing the ceiling 

Place a finger from the other hand on top of the thumb

Press one into the other and hold for 30-45 seconds

Isometric Thumb

Thumb Isometric Adduction

With your thumb facing the ceiling

Place a finger of the other hand next to the thumb

Press one into the other and hold for 30-45 seconds

Trigger Finger/Thumb

Pathophysiology

Thickening at the mouth of the tendon tunnel causing the tendon of the finger to become caught, also known as stenosing tenosynovitis. Incidence higher in women than men, generally age >40 years and increased by 10% in those with diabetes. Ring finger and thumb are most commonly affected.

Symptoms

  • Pain over the site of triggering in the finger or palm surface
  • Stiffness and reduced range of movement in the finger/thumb
  • Locking during flexion and extension of the affected digit as the tendon catches

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy generally not indicated
  • Orthopaedic options include injection, immobilisation through splinting and surgery

Investigations

  • Generally not required

Extensor Tendon Rupture

Pathophysiology

Also known as Mallet finger, is a tear in the extensor tendon beyond normal range of movement. Most commonly occurs in the index, ring and little fingers of the dominant hand. Generally caused by trauma (e.g. ball sports) with contact to the end of the finger or minor injury e.g. catching a finger on a bed sheet.

Symptoms

  • Pain and swelling over the end of a finger
  • The end joint lying in a bent position
  • Inability to actively straighten the end of the finger

Management

  • Within 7 days of rupture send to A&E as primary repair is possible
  • Hand therapy referral 

Dupuytrens

Dupuytrens is a progressive condition of the finger/s causing thickening of the connective tissue in the palm which can cause nodule or cords. These cords slowly contract and pull the digits towards the palm resulting in contracture. Typically this affects the ring finger, followed by the little finger and middle finger respectively. Cause is unknown but more common in Northern European’s, with increased age or with family history. There have also been links with smoking, alcohol consumption, diabetes, epilepsy and long term us of vibrating tools.

Symptoms

·         Skin thickening, pitting or dimpling in the palm

·         Firm nodules fixed to the skin and deep tissue

·         Contracture usually begins in the palm and progresses further down the finger

·         Can often be occur on both hands

Management

·         Activity modification

·         Ice or heat

·         Pain relief

·         Physiotherapy treatment not indicated- education and advice on symptoms/pathology

·         Orthopaedic options are available to those with a significant loss of function for surgical intervention

Investigations

·         Generally not required

Ganglions

Ganglions are cysts which contain a thick clear fluid, often occurring near joints or tendons. They are three times more common in women than men.

 There are 4 main types:

  1. Dorsal ganglion cyst- typically occurs in young adults an disappears spontaneously
  2. Palmar wrist ganglion cyst- associated with wrist OA, but also can occur in young adults
  3. Flexor tendon sheath ganglion cyst- generally younger adults, pain when gripping and feeling like a dried pea sitting on the tendon sheath at the base of the finger
  4. Dorsal digital ganglion cyst- middle aged or older people, pressure from the cyst may cause a furrow in the fingernail and occasionally fluid can leak through the thin overlying skin

Symptoms

  • Smooth and round/oval in nature
  • Usually asymptomatic
  • Can be tender when pressure is applied e.g. gripping
  • Can be fixed to deep tissue but not overlying skin
  • Often disappear spontaneously

Management

  • Physiotherapy treatment not indicated
  • Orthopaedic options include surgical removal

Flexor Tendon Rupture

Pathophysiology

Also known as Jersey finger, is a tear in the flexor tendon beyond normal range of movement. Most commonly occurs in the ring finger and is a forced extension of the end joint of the finger during an active bending movement. Often occurs by catching a finger on another person’s clothing e.g. football or rugby.

Symptoms

  • Pain and swelling over the end of a finger
  • The end joint lying in a relatively straight position compared to the other fingers
  • Inability to actively bend the end joint of the finger

Management

  • Within 7 days of rupture send to A&E as primary repair is possible
  • Hand therapy referral 
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