Common and painful Conditions of theThumb - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the conditions of thumb pain.
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Common conditions of the thumb
https://www.youtube.com/watch?v=VZc9zLCxhtU&t=9s

Common conditions of the thumb–thumb pain
The thumb is important for the normal function of the hand. Many different conditions can affect the normal function of the thumb. It is important to recognize the most common conditions affecting the thumb so that appropriate treatment can be given to the patient.

Stenosing Tenosynovitis (trigger thumb)
One of the more common abnormalities of the hand associated with painful triggering or locking of the thumb. When the patient tries to straighten the thumb the nodule jams beneath the pulley proximally. When this condition is painful or creates severe locking of the thumb, surgery may be helpful. The surgeon should be aware that the radial sensory branch will be in the middle of the surgical field and could be injured from the surgery.

Extensor pollicis longus tendon rupture
The EPL tendon is responsible for extension of the thumbs distal interpharyngeal joint. When the rupture occurs, the patient will experience loss of thumb extension and this typically occurs due to fracture of the distal radius. Rupture of the tendon will prevent extension of the distal pharynx.

Another common condition of the thumb is the entrapment of the posterior interesseous branch of the radial nerve. The posterior interesseous nerve is the continuation of a radial nerve and runs through the forearm. The nerve becomes entrapped at the proximal edge of the supinator. Injury of the nerve may also be associated with fractures or dislocations of the radial head or the elbow joint. The patient will be able to perform wrist extension, but cannot do finger and thumb extension. The patient cannot do the hitchhike sign. The patient with a proximal radial nerve injury will lose wrist extension and finger and thumb extension. Unable to do the okay sign due to anterior interesseous nerve injury. The anterior interesseous nerve comes from the median nerve just below the elbow and supplies the deep muscles on the front (volar side) of the forearm. Typically there will be weakness for the long flexor muscles of the thumb (flexor pollicis longus), and the deep flexor muscles of the index and middle fingers (flexor digitorum profundus). The patient cannot bend the DIP of the thumb or the index finger, and the patient cannot do the okay sign.
Another condition is injury to the ulnar nerve (Froment's sign). The injury to the ulnar nerve can be diagnosed by a test called the Froment's sign. Cubital tunnel syndrome occurs due to compression of the ulnar nerve at the elbow. As a result of cubital tunnel syndrome, the patient is unable to cross the fingers and unable to abduct and adduct the fingers. Injured, of the abductor pollicis muscle becomes weak (supplied by the ulnar nerve). When pinching a piece of paper between the thumb and the index finger, the thumb IP joint will flex if the adductor pollicis muscle is weak (called formant sign that indicates an injury to the ulnar nerve).

Another condition of the thumb is rheumatoid arthritis. There is inflammation or irritation causing pain, swelling, weakness, and over time, loss of the normal shape and alignment of the joints of the hand. This deformity can lead to loss of the ability to grip, grasp, and pinch.
The last condition is CMC joint arthritis (basal joint arthritis) it is hard to differentiate between basal thumb joint arthritis and de Quervain's syndrome. The grind test is used for diagnosing basal thumb joint arthritis. X-rays helpful in identifying basal thumb joint arthritis. The Finkelstein's test is used to diagnose the condition of de Quervain's syndrome (stenosing stenosynovitis of the first dorsal compartment of the wrist). The 2 tendons that are involved are the abductor pollicis longus and the extensor pollicis brevis. The patient will have pain and swelling located over the the radial, the thumb side of the wrist. It is usually located at the base of the thumb, to the side of the wrist. It occurs due to inflammation, thickening, and stenosis of the synovial sheath. This condition is more common in women.

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