Painful and Stiff Thumb - Arthritis or Trigger Points?
Opponens Pollicis / Adductor Pollicis
The symptoms caused by trigger points in these muscles are often mistaken for arthritis.
Origin
Opponens pollicis: flexor retinaculum. Tubercle of trapezium.
Adductor pollicis: oblique fibers: anterior surfaces of 2nd and 3rd metacarpals, capitate, and trapezoid. Transverse fibers: palmar surface of 3rd metacarpal bone.
Insertion
Opponens pollicis: entire length of radial border of 1st metacarpal. Adductor pollicis: ulna (medial) side of base of proximal phalanx of thumb.
Action
Opponens pollicis: opposes (i.e. abducts, then slightly medially rotates, followed by flexion and adduction) thumb so that pad of thumb can be drawn into contact with pads of fingers.
Adductor pollicis: adducts thumb. Antagonists: abductor pollicis longus, abductor pollicis brevis.
Nerve
Opponens pollicis: median nerve (C6, 7, 8, T1).
Adductor pollicis: deep ulnar nerve, C8, T1.
Functional Movement
Examples: picking up a small object between thumb and fingers (opponens pollicis); gripping a jam jar lid to screw it on (adductor pollicis).
Referred Pain
Opponens pollicis: palmar wrist pain at distal radial head and into palmar aspect of thumb.
Adductor pollicis: dorsal and palmar surfaces of thumb, localized around metacarpophalangeal joint and radiating to web of thumb and thenar eminence.
Adductor pollicis - typical referred pain patterns
Opponens Poliicis - typical referred pain pattern
Indications
“Weeder’s thumb,” thumb pain on activity, difficulty maintaining pincer movement, “texter’s/video gamer’s thumb,” pain sewing/ writing/opening jars, loss of fine motor control (e.g. buttoning, sewing, writing, painting).
Causes
Post wrist/thumb fracture, wrist splinting, grasping with thumb, carrying shopping, texting, holding e-reader/tablet, massaging, fine handiwork (e.g. writing, sewing, knitting, artwork, painting, airbrushing), playing musical instruments.
Differential Diagnosis
De Quervain’s tenosynovitis. Osteoarthritis of thumb (saddle joint). Rheumatoid arthritis. Carpal tunnel syndrome. “Trigger thumb.” Discopathy of distal radioulnar joint. Carpal bones dysfunction. Mechanical dysfunction. Fracture. Subluxation.
Connections
Abductor pollicis brevis, flexor pollicis brevis/longus.
Trigger Point Therapy (Self Help)
Self-massage/pressure techniques can be really helpful. Simply locating trigger point and pressing with other thumb may be enough.
Remember to hold trigger point until it softens.
Alternatively, pressure devices can be used (carefully!)
Links
Find a Trigger Point Professional in your area
More Articles About Trigger Points - Hands and Fingers
Trigger Point Therapy Workbooks
Dry Needling for Trigger Points
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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