Mouse use, keyboard activity, use of PDAs and cell-phone texting can all be causes of thumb pain. DeQuervain’s Tenosynovitis is an inflammation of the tendon or tendon sheath at the base of the thumb where it connects to the wrist. The tendons that pull the thumb away from the fingers (into the "hitch-hiking" position) become inflamed and irritated as they pass beneath the ligament that holds the tendons to the bone at the wrist.

Symptoms of DeQuervain’s Tenosynovitis Include:

• Pain at the base of the thumb. As the injury becomes worse, the pain may travel up the forearm or down the thumb.
  
• Swelling at the base of the thumb.
  
• Increased pain with such activities such as wringing motions of the wrist, unscrewing a jar lid, opening a car door, turning a key, or buttoning a shirt.
  
• Increased pain with pinch, grasping, or other thumb movements.
  
• Increased pain with pouring type motions, holding plastic grocery bags, or hammering type motions that pull the wrist down towards the small finger side of the hand.
  
• Clumsiness and dropping objects when pain causes grip to be insecure.

Causes of DeQuervain’s Tenosynovitis Include:

• Activities requiring wringing motions of the wrist.
  
• Repetitive activities that move the wrist in the direction of the small finger, especially with grip (for example, pouring from a pitcher or using a hammer) or if the thumb is held in the palm of the hand (using a buffing or grinding machine).
  
• Holding the thumb rigidly in the hitch-hiking position (for example, when held tensely off the keyboard while typing).

Preventing DeQuervain’s Tenosynovitis:

• Work with the wrist in a neutral position. The wrist should not be bent forward or back or tilted to one side or the other.
  
• Use ergonomically designed tools with modified handles that help maintain the wrist in a neutral position if they are available. The split keyboard can help position the wrist in a more comfortable, less stressful position.
  
• Avoid holding the thumb in the palm of the hand while bending the wrist towards the palm or towards the small finger side of the hand.
  
• Minimize repetition.
  
  • Periodically rest the arms briefly during repetitive or stressful activity.
    
  • Stretch often during repetitive activity.
    
  • Slow down the activity.
    
  
  
• Use the lightest grip possible (on tools, pens, the mouse, the steering wheel, etc.) that still allows you to maintain good control.
  
• Use the least amount of force necessary during the activity.
  
• Alternate work activities so the hands are not performing any one task repetitively for any length of time.
  
• Use the shoulder to provide movement instead of using isolated wrist movements (for example, while fastening nuts and bolts or when holding the computer mouse).
  
• Use a power grip when possible (for example, holding an object with all the fingers in a loose grip) instead of using a pinch.
  
• Use the appropriate tool for the job.
  
• Make sure that tools are in good condition and that cutting edges are sharp (reduces the force needed to use the tool).
  
• Use power tools (such as an electric screwdriver) when possible.
  
• Use tools that provide leverage.
  Work in the mid-range of motion. Don't move the wrist through extreme ranges of motion.

If You Are Having Thumb Pain:

• To rest the tendon and allow swelling to go down, use a splint or brace that holds the wrist in a neutral neutral position and the thumb in a relaxed, functional position (a thumb spica splint).
  
• Avoid the activities which cause pain, especially those requiring pinching and pulling with the thumb. Modify activities that can not be avoided.
  
• Use ergonomic equipment and tools such as split keyboards and hammers with a specially designed handle that holds the wrist neutral.
  
• Use cold packs several times throughout the day to reduce inflammation.

Check out these related articles for further information on relieving thumb pain caused by repetitive strain injury.

Typing Style – Repetitive Injuries are NOT Just About the Keyboard

PDA & SmartPhone Ergonomics


Use of Heat & Cold to Relieve Repetitive Strain Pain


The Wrist & Repetitive Strain Injuries

My Product Choices as First Line of Defense Against Repetitive Strain Thumb Pain

This is a sample of the Comfort Cool Thumb Support available at Amazon.com. These are very comfortable supports that allow some mobility and function while limiting end-range thumb motion so that the tendons can rest, reducing inflammation.

These are very comfortable cold packs available from Amazon.com. My clients in the hand therapy clinic love these packs. The gel stays soft and pliable, providing good contact to bony areas. These are durable, comfortable packs that will not leak. The Velcro strap holds the pack in place allowing you to have some mobility while you perform your cold therapy. These packs can also be placed in the microwave for heat therapy.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.