Evaluation of the patient with thumb pain
- James Bray, MD
James Bray, MD
- Assistant Professor of Family Medicine
- Texas A&M Health Science Center College of Medicine
- Sara Neal, MD
Sara Neal, MD
- Associate Professor of Family Medicine
- Moses Cone Health System
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Injuries to the hand, wrist, and fingers, including the thumb, are common. According to the National Hospital Ambulatory Medical Care Survey for the year 2004, 11.3 percent of all visits to United States emergency departments involved such injuries .
This topic will review how to perform the initial evaluation of patients with thumb pain, whether from injuries or other conditions. Finger and thumb anatomy and detailed discussions of specific injuries and conditions are found separately. (See "Finger and thumb anatomy".)
For finger and hand injuries: (see "Distal phalanx fractures" and "Middle phalanx fractures" and "Proximal phalanx fractures" and "Digit dislocation reduction" and "History and examination of the adult with hand pain" and "Overview of metacarpal fractures").
For other conditions: (see "Clinical manifestations and diagnosis of gout" and "Diagnosis and differential diagnosis of rheumatoid arthritis" and "Overview of hand infections" and "Clinical manifestations and diagnosis of osteoarthritis").
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- Bodor M, Fullerton B. Ultrasonography of the hand, wrist, and elbow. Phys Med Rehabil Clin N Am 2010; 21:509.
- Hong E. Hand injuries in sports medicine. Prim Care 2005; 32:91.
- Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med 2006; 25:527.
- Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32:262.
- DeLee, JC, Drez, D. Orthopaedic Sports Medicine: Principles and Practice, 2, WB Saunders, Philadelphia 2003.
- Eiff, MP, Hatch, et al. Fracture Management for Primary Care, WB Saunders, Philadelphia 2003.
- Merrell, Greg, and Slade, Joseph F. Dislocations and ligament injuries in the digits. In: Green's Operative Hand Surgery, 6th ed, Wolfe, SW, Hotchkiss, RN, Pederson, WC, Kozin, SH. (Eds), Elsevier, Philadelphia 2011. Vol 1, p.323.
- Rockwood, CA, Green, et al. Rockwood and Green's Fractures in Adults: Part 1., 3rd, JP Lippincott, New York 1991.
- FUNCTIONAL ANATOMY
- DIAGNOSTIC IMAGING
- Plain radiographs
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- SOFT TISSUE INJURIES
- DEFORMITY: DISLOCATION AND FRACTURE
- General approach and management
- Deformity at the CMC joint
- Deformity at the MCP joint
- Deformity at the IP joint
- Fracture of the proximal phalanx
- Fracture of distal phalanx (tuft fracture)
- JOINT INSTABILITY
- MCP joint instability
- - Ulnar collateral ligament injury (skier’s thumb)
- - Radial collateral ligament injury
- IP joint instability
- NONTRAUMATIC THUMB PAIN
- Stenosing flexor tenosynovitis (Trigger thumb)
- de Quervain’s tenosynovitis
- Carpal tunnel syndrome
- SUMMARY AND RECOMMENDATIONS