You Have A Social Media Disease
There Is No App for Thumb Pain
Your thumb is made up of an intricate system of tendons that enable very precise movement. The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit. In this age of all things digital, the modern American thumb has been subjected to greater workloads. Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy. I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.
Thumb Tendon Troubles
Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome. The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test. Place your thumb in the palm of your hand. Make a fist with the finger around the thumb. Hold the wrist in neutral and then deviate the wrist toward the pinkie finger. If you feel pain it is a positive Finkelstein test.
Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities. Rest the thumb tendons by using your fingers instead of your thumb on that smart phone. Avoid fitness activities that put stress on the thumb. Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons. Early on in the pain onset, icing is often helpful. In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy. A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.
The Numb Thumb
Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain. An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger. Patients with neural irritation often develop numbness, weakness, and then pain. The pain often wakes them from sleep and disrupts hand function.
Once again, you will resolve a numb thumb with rest. Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon. Giving in to the numbness and resting the hands will produce better results if you start early. Two weeks of avoiding the aggravating hand activity produces good results. Night splints for the wrist and thumb are often helpful. A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.
Gumbie Thumb Beware
Every joint has a certain degree of stability and certain degree of mobility. Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart. The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad. The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.
The Beighton Score is a popular screening technique for joint hypermobility. It has been around for thirty years and is used in research all around the world. The scoring is based on eight passive range of motion assessments and one active range of motion assessment. One point is assigned for each of the following.
A pinkie finger that can be passively bent backward more than 90 degrees.
A thumb that can be pulled down to the front of the forearm.
Elbows that passively hyperextend to 10 degrees.
Knees that passively hyperextend to 10 degrees.
The subject can place the palms on the floor during a straight leg, forward bend.
Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility. I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs. It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9. Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.
Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times. Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.
Michael S. O’Hara, PT, OCS, CSCS
How To Make Stress Urinary Incontinence Go Away
Stress Urinary Incontinence (SUI) is a common problem in the female population. SUI responds very well to a proper rehabilitation exercise program and modification of behavior. Unfortunately, most women are either not directed or do not seek care for this problem.
SUI problems are happening to more women at younger ages. The overall fitness level of younger women has dropped and problems with SUI are happening sooner. Obesity, surgical interventions through the abdominal wall, and pelvic floor and systemic diseases such as diabetes all contribute to an earlier onset of SUI.
Women in the fitness population often suffer from what I call Permanently Contracted Abdominal Muscles (PCAM). They hold their abdominal muscles in a perpetually pulled in position and their pelvis tilted backward. They are unable to relax their abdominal muscles and properly inhale and exhale. PCAM creates hypertonicity and weakness in the muscles of the pelvic floor. It is also the reason many postpartum women develop a chronic diastasis recti hernia.
Modification of fitness activity is often necessary to resolve SUI in female fitness clients. Many exercises overload the pelvic floor and impair the motor control necessary to prevent leakage. You may have to temporarily give up the crunches, leave the yoga and lose the lifting belt in order to ditch the dribble. Once SUI problems have resolved you will be able to go back to all activities. My experience has been that most female fitness clients find they function so much better that they never return to those activities.
Physical therapy patients treated for SUI are often surprised by how simple changes in behavior and consistent training quickly resolves their leakage issues. It is unfortunate that many of these women suffer with SUI for years before receiving some help. I had a patient tell me that she thought SUI was just part of being a mom. Her mother had SUI, and after delivering two children of her own, she developed symptoms. All of her problems with SUI were eliminated with three months of simple exercise and some alteration of fitness activity.
Take a few minutes and read the article by physical therapist Ann Wendel on the Girls Gone Strong web site. She does an excellent job of covering all areas of physical therapy for SUI. You can view the articles here: https://www.girlsgonestrong.com/blog/injury-prevention/strong-pelvic-floor-isnt-enough/
-Michael O’Hara, P.T., OCS, CSCS
Marty woke one morning feeling like he was on a carnival ride. The room was spinning and any attempt at walking left him feeling sick. His wife feared he was having a stroke and called EMS. After an ambulance ride to the hospital, blood work, and an MRI of his brain, he was sent home with some medications and orders to see his family physician. Three weeks later Marty arrived in our clinic.
Marty had a typical case Continue reading