What are the common causes of thumb-sided wrist pain?

There are many causes of thumb-side wrist pain, with the two most common ones being,

1. DeQuervain’s tenosynovitis is the most common cause of thumb-side wrist pain. It is a condition in which pain occurs at the wrist joint, near the base of the thumb, due to inflammation of the thumb tendons around the base of the thumb. You may also notice swelling at the base of the thumb. The pain is especially noticeable when you form a fist, or when you grasp/ grip something.

2. Carpometacarpal joint (CMCJ) osteoarthritis. The CMCJ is the joint formed between the thumb and the wrist, and is important for thumb function. This condition occurs when the joint cartilage over the CMCJ is worn out, causing pain with thumb movements. Patients frequently notice an abnormal bump at the base of the thumb, and will also experience weakness and limitation of thumb movements in addition to pain.

How does DeQuervain’s tenosynovitis occur?

The exact cause of DeQuervain’s tenosynovitis is not fully understood, however, repetitive trauma or overuse of the thumb/ wrist in daily activities has been linked to the disease. Activities such as repetitive thumb motions, repetitive gripping motions, such as in wringing of wet clothes, are among the activities that are known to predispose to DeQuervain’s tenosynovitis

How is my thumb sided wrist pain assessed?

The doctor will first conduct a medical interview, where information such as the location of pain, the type of pain, and the activities that might have triggered the pain will be sought. Based on this information, a focused medical examination will be conducted, where the doctor will try to elicit pain by palpating on the affected area and performing provocative tests on your wrist.

In general, DeQuervain’s tenosynovitis is a clinical diagnosis, however, if there is any diagnostic doubt, plain X-rays of the wrist may be offered. These X-rays are especially useful to detect CMCJ OA as a differential diagnosis. Further imaging such as MRI scans may also be offered to further delineate the cause of the wrist pain.

How is DeQuervain’s tenosynovitis treated?

Non-surgical

Majority of patients with DeQuervain’s tenosynovitis can be treated without surgery. Options include,

1. Resting the injured portion, by avoiding activities which cause pain.

2. Medications such as non-steroidal anti-inflammatory pain medication can be used to treat pain and swelling.
3. Splintage of the thumb and wrist, will immobilise the injured tendons, and aid recovery.
4. Hand and thumb therapy with a certified occupational therapist will improve function and hasten recovery.
5. Injection therapy with steroid and local anaesthetic is successful in majority of patients (~60-70%) if performed in combination with rest and therapy.

Surgical

Surgery for DeQuervain’s tenosynovitis is only recommended if non-surgical treatments fail to work. Surgical decompression of the affected tendons is undertaken through a small incision. This procedure can be performed as a day surgery, and patients can usually be discharged a few hours after surgery.

In general, stitches will be removed 1-2 weeks after the surgery, and your hand should heal completely in 3-6 weeks.

For an assessment of your condition, please book an appointment with Dr. Yong Ren.

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