The structure of thumb gives it special qualities. The muscles of thumbs are the most mobile of all digits, which allows thumb to move in different directions. The stability of the thumb is mostly obtained from coordinated and active muscular tension. Thumbs are good in performing activities such as needle work, writing, playing musical instrument, using tools, gardening, using keyboards and typing the text messages on mobile phone. Due to these increased levels of work, thumbs are subjected to a lot of repetitive functions which leads to their overuse over a period of time and they get tired. This can lead to pain in the thenar eminence, the soft muscular part at the base of the thumb.
What is Thenar Eminence Pain?
The soft muscular rounded part at the base of the thumb is called Thenar Eminence.1 Due to overuse, this portion of thumb gets inflamed and results in thenar eminence pain. Pain in thenar eminence affects performance of the daily activities such as opening of drawers, handling of the latch and opening of the door etc.
Symptoms of Thenar Eminence Pain
- Pain around the soft muscular rounded part at the base of the thumb is a symptom of thenar eminence pain.
- Tightness of thenar eminence.
- A nodule at the base of the thumb along the palmar surface.
- The thumb gets locked after flexing it can be a symptom of thenar eminence pain.
- Neurovascular compression.
- Symptoms of carpal tunnel syndrome.2
Epidemiology and Prognosis of Thenar Eminence Pain
The occurrence of thenar eminence pain is a very common problem. Pain in thenar eminence mainly affects females in their menopause age. However, it is also observed from age 8 to 82 years. If untreated the prognosis of thenar eminence pain may not be very good. However, when activities are kept in control and if early treatment for thenar eminence pain is initiated, it may result in good prognosis.
Causes of Thenar Eminence Pain
Thenar eminence pain is caused due to fine and repetitive nature of work, which leads to chronic overuse of the thumb. Few examples of which include constant typing on mobile phones and laptops, work of a massage therapist, hammering, sewing and so forth. Hormonal changes in women, particularly postmenopausal can be one of the major risk factors of thenar eminence pain.
Pathophysiology of Thenar Eminence Pain
In thenar eminence pain rather than the thumb itself, the muscles in thenar eminence portion experiences pain. Since it contains the primary muscles of finger to thumb, which help in gripping and performing activities, this muscle is often overused. Due to over-activity, these muscles get inflamed and as a result the thumb joint at the base greatly suffers. This leads to development of joint, muscle and tendon inflammation causing thenar eminence pain. Further, there is tightness and then stiffness of thumb with an overall or specific thumb pain. The functions of the thumb become slow and weak. As the inflammation progresses, the joint changes its shape and move outwards. There will be presence of a nodule on the middle knuckle. The minor pain may progress to constant ache. Due to thumb weakness, there is problem in gripping of things. The over-activity of thenar eminence and lack of treatment leads to rigidity of the thumb and will restrict its movement completely.
Diagnosis of Thenar Eminence Pain
The doctor performs physical examination and records medical history and notes down the symptoms experienced by the patient. Further use is made of thenar eminence pressure test and carpel tunnel compression test for routine examination and diagnosing the condition.
Treatment for Thenar Eminence Pain
The aim of treatment for thenar eminence pain is to reduce the pain. Treatments options for pain in thenar eminence include:
- Splinting of the thumb to immobilize the thumb is an effective way to manage thenar eminence pain.
- Non-steroidal anti-inflammatory drugs (NSAID’s) may be prescribed for pain in thenar eminence.
- Steroid injections.3
- Palpation of the neck and adjustment of C5 to C7 and T4 vertebrae by the physiotherapist or the orthopedic surgeons.
- Surgery for thenar eminence pain might be required in severe cases, which helps in tendon release. It is used rarely when all the above mentioned therapies do not work.
- Generally, combined treatment of the above strategies is used to treat thenar eminence pain.
Alternative Therapies for Thenar Eminence Pain
- Acupressure and Acupuncture can help in reducing thenar eminence pain.
- Cold compression is applied around the thenar eminence area for at least 10 minutes for few times in a day. This helps to reduce pain and inflammation.
- The thenar eminence if subjected to deep tissue massage, can allow relaxing the tight musculature.
- Thumbs should be kept loose and mobile, and it should be stretched gently. This will prevent tightening of muscles.
- There are other therapies such as Mobilization, Myofascial release, Trigger point and Microcurrent, which can also help in providing symptomatic relief.
Prevention of Thenar Eminence Pain
One can prevent suffering from Thenar Eminence pain by avoiding activities, which require constant use of the thumb. In case of thenar eminence pain due to repetitive nature of work, one need to take frequent breaks to let the thumb and its muscles relax and also do free hand stretches to prevent rigidity of the muscles.
Thenar Eminence pain commonly affects people who are involved in overuse of thumb in their daily activities. If detected early, it can be treated with an appropriate therapy which has a good prognosis.