Author: Paul Meirick, MD
Co Author #1: David G. Liddle
Editor: Stacey Dault, DO
Right Thumb Pain
A 25-year old male CrossFit champion with one year of right thumb pain. His pain is located on the radial aspect of his first right metacarpophalangeal joint. The symptoms started insidiously last year while he was training for a competition. There is no history of trauma, pop, or snap. The patient notes a sharp pain over the radial aspect of his metacarpophalangeal joint when utilizing a hook grip Case Photo #1 for the Snatch, a CrossFit and Olympic lift. Thus far, he has tried resting his thumb, a neoprene thumb spica brace and a nonsteroidal anti-inflammatory drug, but none have provided relief.
This is a healthy appearing male. The left hand is unremarkable. Inspection of the right hand reveals callouses over the palmar aspect of his metacarpophalangeal joints, but otherwise reveals no swelling, atrophy or deformity. Palpation of the right thumb reveals tenderness along the radial aspect of the metacarpophalangeal joint, but no masses or crepitus. Thee is full and painless range of motion of the right thumb interphalangeal, metacarpophalangeal and carpometacarpal joints. Sensation and pulses of the right hand are normal. Tinel and Phalen tests are negative. Ulnar deviation of the wrist with thumb enclosed - Finkelstein test, CMC grind, and scaphoid shift - Watson test - are all negative. When the metacarpophalangeal joint is stressed by radial deviation at 30 degrees of flexion, there is ncreased laxity relative to the contralateral side, with firm endpoint. Interestingly, this radial deviation casuses pain on the radial aspect of the joint. There is no laxity or pain of the first metacarpophalangeal joint with ulnar deviation.
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