pain and disability in the thumb

main complaint

pain in the right thumb and clicking when moving it.
it's been 7 months since it started hurting.
he went to various places for treatment.
pain in the right thumb joint.
it clicks when he moves it.
pain also occurred when stretching the tendon of the thumb.
at first, he went to an osteopathic clinic and received electric and ultrasound therapy, but it did not get better.
then he went to an orthopedic doctor and was told to rest and immobilize, but this didn't help either.
after that, he went to an acupuncture clinic and was treated with acupuncture and moxibustion, but this did not improve either.

visual observation and palpation

the flexion movement of the thumb was quite restricted.
palpation revealed strong tension in the forearm, and since more than 7 months had passed since the initial pain, i judged that the current symptoms were caused not only by the area related to the thumb, but also by the involvement of various muscles.

treatment

initially, thin acupuncture needles were applied to the thenar to improve the abduction and opposition movements of the thumb.

thenar muscles (A short thumb abductor, B maternal opposable muscles, C short thumb flexor, D maternal adductor)

(1) short thumb abductor muscle
(2) maternal opposable muscles
although it is not shown in the figure, i also intensively treated the short thumb flexors.

after that, as the pain itself had decreased, the disability to move with a click became more noticeable, and we treated the extensor muscles such as the extensor digitorum longus, extensor digitorum brevis, and abductor pollicis longus.

we also concentrated on treating the forearm muscles such as the short radial carpal extensors because we thought that the abnormal movement of the various muscles caused the long-term symptoms that continued to burden the thumb as in this case.

in addition, i concentrated on the treatment of the infraspinatus muscle, judging from the fact that his occupation involved a lot of writing.

the current pain has decreased to 1 from 10 at the beginning. there is still some concern about the clicking movement, but it is expected to improve in the future.

the treatment is still ongoing.

Summary

detailed treatment of small areas

in general, electrotherapy such as SSP and ultrasound are often used for detailed treatment, but the longer the symptoms are prolonged, the less improvement can be achieved with such treatment at the level of improving circulation.

the fact that the symptoms persist means that the cause of the problem is not being approached accurately, and the treatment plan needs to be changed immediately.

this time, the cause of the pain is trigger points formed in each small muscle, and the movement disability is thought to be caused by poor muscular coordination of small muscles.

for example, if you suddenly have a pain in the sole of your foot or a pain in your knee, it is natural to examine the sole of your foot or the knee, but why? but why did it hurt? when you think about it, you should consider abnormalities in muscle coordination caused by trigger points in the lower back or in the buttocks that you have no subjective symptoms of.

even if the local symptoms improve, it is often only a temporary improvement, and if you are going to treat it anyway, you need to have a treatment concept to heal it fundamentally.

Case Reports