What's Causing Your Thumb Pain?

Our thumbs are key parts of our hands. Opposable thumbs allow us to use tools and our hands more dynamically. When they hurt, it’s not just about the pain, but also the functional limitations it causes.

Thumb pain can stem from joint issues. This can be due to wear and tear arthritis from overuse over many years, or inflammation from conditions like rheumatoid arthritis, gout, or other types of inflammatory arthritis. Generally, if your pain is worse with activity, it’s likely wear and tear arthritis. If it’s worse with rest, it’s likely inflammatory arthritis.

Several tendons around the thumb provide motion, range of motion, and power. Pain location can indicate which tendon is damaged. Pain on the backside of the thumb when extending it may indicate De Quervain’s tenosynovitis. Pain on the other side causing triggering or catching of the thumb may indicate an irritation of the flexor tendon, known as trigger thumb or trigger finger.

Ligaments connect bones and provide support and stabilization. Overusing your thumbs, such as from texting or computer use, or an acute injury from sports or work, can overstretch the ligaments, leading to joint instability and pain. Chronic ligament instability can also lead to arthritis.

Nerves supply sensation to the thumb and can get compressed or irritated, causing pain. For example, compression of the median nerve at the wrist can cause carpal tunnel syndrome, leading to pain in the thumb. Compression of the radial nerve can cause pain and tingling in the back of the thumb. Irritation of the C6 nerve root in the neck can also cause thumb pain.

As a physician, several key factors are considered to diagnose thumb pain:

What are your symptoms? Pain with specific activity, triggering in the thumb, numbness and tingling, or swelling can help direct the diagnosis towards joint, tendon, ligament, or nerve-related pain.

Tenderness during examination can indicate the source of pain. Joint tenderness, tendon tenderness, nerve compression, or swelling in the joint are important clues.

Imaging can also be helpful. X-rays can show arthritis, while ultrasound can detect inflammation, joint instability, or soft tissue injuries. MRI is rarely needed but can be used for more subtle injuries. EMG or nerve conduction studies can diagnose pinched nerves at the wrist, elbow, or neck.

Based on symptoms, examination, and imaging, the cause of thumb pain can be determined. Treatment depends on the specific problem causing the pain.

For more information on treating these issues, check out our other content.

To learn more: https://www.ChicagoArthritis.com

Why Does Your Front / Side Hip Hurt When You Sleep at Night?

A common complaint among many people is experiencing pain at nighttime when sleeping on one side or the other. To figure out what's causing this, there are a couple of things you need to do.

The first step is to differentiate between pain on the side of the hip (lateral hip) versus pain in the front of the hip. Pain in the front of the hip is more commonly associated with the hip joint, the labrum, or the hip flexor tendon. Although sometimes it can cause pain on the side of the hip when sleeping, it usually presents differently.

Several classic issues can cause pain on the side of the hip:

1. SI Joint or Ligament Issues: The sacroiliac (SI) joint connects the pelvis to the hip and is a key stabilizing joint. Pain here can radiate to the lower back, side of the hip, and down the leg. SI joint ligament strains or laxity, often from injuries or activities, can also cause pain.

2. Tendonitis or Bursitis: Tendons like the gluteus medius and minimus insert on the side of the hip. Weak hip muscles can overstrain these tendons, causing tendonitis. Direct contact can aggravate the tendons, leading to pain. The bursa, a small fluid sac on the side of the bone, can get irritated, causing bursitis.

3. Pinched Nerve: Chronic lower back pain or arthritis can pinch a nerve at the L3 or L4 level, causing pain on the side of the hip.

4. Other Soft Tissue Irritations: Muscles like the piriformis or hip ligaments strains can also cause side hip pain.

To determine the cause of hip pain, consider the following:

• Pain Location: Is the pain in the front or side of the hip?

• Examination: A physician can assess hip movement, tenderness, and neurologic findings to identify the cause.

• Imaging: X-rays can evaluate bones, while MRI scans are useful for soft tissues like tendons and ligaments or to check for pinched nerves.

Treatments depend on the cause. Common approaches include:

• Core and Hip Strengthening: Exercises to strengthen the core and hips can alleviate instability-related pain by reducing pressure on affected structures.

• Advanced Treatments: If conservative options fail, treatments like prolotherapy or platelet-rich plasma (PRP) can strengthen areas of instability and reduce pain.

To learn more: https://www.ChicagoArthritis.com

Can Rotator Cuff Injuries Get Better Without Surgery?

A common question that patients have is whether a rotator cuff injury can get better without surgery.

The rotator cuff is a group of muscles and tendons around the shoulder that provide strength and control. These four muscles start at the scapula and wrap around the shoulder, allowing a full range of motion, power, and stability. This incredible structure, however, is prone to injuries.

1. Tendinopathy: Mild injury with fraying and inflammation of the tendon.

2. Partial Thickness Tears: A small portion of the tendon is torn, but most of it remains intact.

3. Full Thickness Tears: The tendon is completely torn through. These can be:

   • Non-retracted Tears: The tendon edges are still close together.

   • Retracted Tears: The tendon ends are pulled apart.

No, not all rotator cuff injuries require surgery:

• Tendinopathy: Often treated with physical therapy or rest. Prolotherapy or PRP treatment may be considered if needed.

• Partial Thickness Tears: Most cases (about 80%) improve with physical therapy. If necessary, regenerative medicine treatments like platelet-rich plasma can be used.

• Full Thickness Tears:

• • Non-retracted Tears: Physical therapy can help 75% of people avoid surgery. Treatments with bone marrow-derived stem cells mixed with fat cells can be effective.

  • Retracted Tears: Surgery is often required. After surgical repair, there's a high risk of re-tearing (25-75%). Augmenting with bone marrow-derived stem cells can help strengthen the tendon and prevent recurrence.

Rotator cuff injuries can be very painful, but there are many conservative treatments available that can often work before considering surgery.