While science explains how changes in our daily physical activity result in changes in our physical state, current culture seems to dictate the terms we use to identify these changes – reflecting what’s going on in the world around us.
In early hunting days (1955), Gamekeeper’s Thumb was coined by an orthopedic surgeon who repeatedly diagnosed Scottish gamekeepers with a thumb condition seemingly associated with the manner in which they killed small animals – and carried their game home in a leather thong attached to their thumb and draped over their shoulder.
Over time it became more commonly referred to as Skier’s Thumb – as similar damage occurred to skiers falling against a planted ski pole. Our affection for the slopes boosted the popularity of the new terminology.
Similarly today’s activities have resulted in a new way to incur a long established condition – and the terminology associated with the diagnosis will provide future generations with some insight into the culture of our day!
Known as “Texter’s Thumb,” (also BlackBerry Thumb and Gamer’s Thumb),
de Quervain’s Disease or Syndrome is a painful inflammation of the tendons (fibrous connective tissue attaching muscle to bone), which control thumb movement and extend to the wrist (tenosynovitis). The inflamed and swollen tendons and their coverings rub against the narrow tunnel through which they pass – causing pain at the base of the thumb which may extend to the lower arm.
Historically, this condition has also been called washerwoman’s sprain, mother’s wrist and mommy thumb.
Considered a repetitive stress injury (RSI), de Quervain’s Disease is often the result of repetitive activity/grasping – which results in irritation of the tendons and other soft tissue in the thumb. The condition may also be caused by a direct blow to the thumb and inflammatory conditions such as rheumatoid arthritis.
In the activity of texting, it is thought that the problem is not caused by the tip of the thumb pressing the keys on a phone, but rather the frequent traveling of the thumb over the keyboard. The thumb joint is not meant to move rapidly in this manner – the confined space adding insult to injury.
Symptoms of Texter’s Thumb
Common symptoms of Texter’s Thumb (de Quervain’s syndrome) include swelling and pain that can run from the tip of the thumb to the wrist and into the forearm. This pain is primarily present when the wrist is flexed or turned – as well as when forming a fist or grabbing. There can also be pain when direct pressure is applied to the area.
Diagnosing Texter’s Thumb
To diagnose de Quervain’s, a physical examination and discussion of lifestyle and activity is assessed. A Finkelstein test may also be performed. This entails placing the thumb against the hand, making a fist with fingers closed over the thumb and then bending the wrist towards the little finger. Pain with this maneuver is a positive test.
Generally, this type of injury is treated conservatively and entails refraining from texting for a while (activity modification) and resting the affected thumb(s). Non steroidal anti inflammatory medication (NSAIDs) may also be prescribed and a splint that incorporates the thumb may be indicated. When pain persists despite rest and refrain from the activity causing the condition, a steroid injection may be recommended. In chronic or severe cases, surgery to release the pressure in the compartment is performed – followed by rehabilitation therapy to regain strength. If untreated, the synovial sheaths will continue to thicken and degenerate. This can result in permanent damage and loss of grip strength and chronic pain.