Causes of Pain in the Thumb and Wrist

Thumb and wrist pain can significantly interfere with your daily activities. The bones, joints, ligaments and tendons in the thumb and wrist can all suffer injury or inflammation that leads to pain. Overuse and repetitive motion injuries, sports-related accidents, falls and aging are among the culprits that cause thumb and wrist pain. As treatment depends on the underlying cause of your pain, see your doctor for an accurate diagnosis.

Osteoarthritis, also known as degenerative arthritis, is the most common form of arthritis and often affects the wrist and thumb, as well as the fingers. The condition develops as cartilage breaks down in a joint due to wear and tear over time. As this padding between the bones thins out, pain and stiffness develop. Eventually, the bones may rub against each other and cause severe pain. Osteoarthritis may affect one or more joints in the thumb and wrist. However, it does not always affect multiple joints at the same time, and the severity of joint damage commonly varies between the involved joints. Additionally, osteoarthritis may affect only one hand or wrist.

The carpometacarpal (CMC) joint at the base of the thumb near the wrist suffers considerable wear and tear over a lifetime. This joint often develops osteoarthritis relatively early in adulthood. Basal joint arthritis may interfere with the ability to pinch or grip with the thumb. Treatment for osteoarthritis of the wrist and thumb may include splinting, physical therapy, anti-inflammatory medication, cortisone injections or surgery.

Other types of arthritis can also affect the wrist and thumb. Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system mistaken attacks the tissues of the joints causing inflammation and destruction. Roughly two-thirds of people with RA experience wrist and hand involvement, typically affecting both hands simultaneously. People with RA frequently experience other systemic signs and symptoms, such as low fevers and fatigue.

Psoriatic arthritis is a consideration in people with wrist or thumb pain along with psoriasis of the skin or nails. In addition to typical skin and nail lesions, this chronic inflammatory condition causes joint swelling, pain and stiffness, as well as possible ligament and tendon pain. The disease commonly affects the small joints of the hands and wrists, as well as those of the feet and toes. Other larger joints may also be involved.

Treatment for wrist and thumb pain caused by these types of arthritis may include some of the same measure used for osteoarthritis. Medications called disease-modifying antirheumatic drugs (DMARDs) are also commonly used to slow or arrest disease progression and joint destruction.

In addition to powering muscles, nerves supply sensation to the thumb and wrist. Nerve compression -- often caused by repetitive motion activities or direct trauma -- can lead to pain in these areas. Carpal tunnel syndrome, a repetitive motion injury, develops when swelling compresses the median nerve in the wrist. Carpal tunnel injuries cause aching, burning pain in the wrist, thumb or fingers, often accompanied by numbness and tingling that may extend as far as the elbow. It may be difficult to grasp with the thumb. Splints and anti-inflammatory medications help reduce swelling, however surgery may be required to relieve pressure on the compressed nerve.

Inflammation of the tendons that move the thumb and wrist can cause significant pain. This condition, called tendinitis, is typically caused by repetitive movements or direct trauma. Tendinitis can affect any tendons in the wrist and thumb. De Quervain's tendinitis is a common condition that causes thumb and wrist pain due to inflammation of the tendons that pass through the wrist and into the thumb. Movement of the thumb may also be accompanied by a snapping or catching sensation. Splinting, anti-inflammatory medications and cortisone shots are used to decrease pain in mild cases of De Quervain's tendinitis. Surgery is sometimes performed to relieve pressure on the inflamed tendons.

Ganglion cysts are noncancerous, fluid-filled sacs that develop next to joints or tendons. These cysts contain thick fluid similar to that which normally lubricates many joints. Ganglion cysts often cause no symptoms unless they impinge on nerves. For example, a ganglion cyst on the thumb side of the back or front of the wrist can compress local nerves, leading to pain in the thumb or wrist. Many ganglion cysts resolve on their own, while some grow into bone. Ganglion cysts may require cortisone injections, drainage or surgery.

Thumb and wrist pain can be caused by trauma affecting bones and ligaments in these joints. The ulnar collateral ligament (UCL), located on the inside of the base of the thumb, is particularly susceptible to injury when the thumb is forced away from the hand. This injury is often called skier's thumb or gamekeeper's thumb because these are common mechanisms of UCL trauma. Treatment depends on the extent of ligament damage and typically includes casting or splinting to allow healing. Severe UCL tears may need to be surgically repaired.

Bone fractures can also cause thumb and wrist pain. For example, injury to the scaphoid bone at the base of the thumb causes pain and tenderness on the thumb side of the wrist. Scaphoid fractures sometimes heal with casting, but may require surgical repair, depending on the severity of injury.

See your doctor for any unexplained, persistent, severe or worsening pain in the wrist or thumb. Seek medical attention as soon as possible if the pain is associated with a traumatic injury. For most condition causing wrist and thumb pain, early diagnosis and treatment helps limit your discomfort and reduced the risk for long-term limitations or disability.

Reviewed and revised by: Tina M. St. John, M.D.