Diagnosing the cause of thumb joint pain can be quite tricky due to the several factors that can attribute towards causing it. Many times more than one factor play an important role and have to be modified or eliminated in order to gain full benefit of the treatment. Acute injuries due to a single traumatic incident, are simple injuries as far as diagnosis is concerned. A single x-ray examination in the ER of a hospital can be sufficient to diagnose most of the fractures or dislocations, causing thumb pain.
Diagnosis of degenerative disorders, like DeQuervain’s tenosynovitis, RSI of thumb or blackberry thumb, and so on, requires a detailed history into the activities performed by a person. In this step, it is very important to disclose minute details regarding use of cell phones, computers, or other similar gadgets. A few clinical tests may be performed by an orthopedist, to clear the doubt regarding the cause of thumb joint pain.
Finkelstein’s Test – is a test for DeQuervain’s disease, where a person is asked to make a fist and the fist is forcibly moved in a direction away from the thumb. The appearance of sharp pain with slight movement indicates a positive test and the presence of DeQuervain’s disease, which is an important cause of thumb joint pain. This test may also be used for diagnosing blackberry thumb or keyboard related thumb pain.
Video 1: Finkelstein’s Test
Phalen’s Test – is a test for carpal tunnel syndrome, which is another cause of wrist and thumb pain. It consists of keeping the back of both hands together and raising the wrists higher, which causes bending of both wrists to maximum capacity, simultaneously. If pain is felt within 60 seconds, it indicates a positive test and also presence of carpal tunnel syndrome, which affects the median nerve at wrist. This nerve also supplies the thumb and can lead to thumb pain.
Video 2: Phalen’s Test
Fist Test – is a specific test for keyboard related thumb injury, where a person is asked to make a tight fist by encircling the fingers over the thumb. If one is unable to make a tight fist in this manner, due to thumb joint pain, one can be certain to have RSI of thumb due to frequent use of keyboard. If pain occurs in both the thumbs, it can be due to blackberry thumb or RSI of thumb due to use of QWERTY keypad cellphones.
These clinical tests are quite simple to perform and also reliable when performed correctly. They are very useful for quick diagnosis and many times defer the need for an MRI scan, which is expensive.
MRI for Thumb Joint Pain – is the last resort when it comes to diagnosing doubtful cases of thumb joint pain. It is one of the best investigations for chronic degenerative diseases of thumb as well as for acute soft tissue injuries. It gives the exact location and extent of the disease, helping greatly to direct treatment options and predicting the outcome. Apart from it being expensive, there are no known disadvantages. It is does not cause exposure to harmful radiations and is relatively safe in all patients.
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