Why Does My Thumb Hurt When I Grip? A Surgeon Explains

Most thumb pain does not announce itself at rest. It waits for a jar lid, a door handle, a key that will not turn, or the moment you pinch a sheet of paper and feel a sharp complaint at the base of the thumb. The pain fades when you let go, which is exactly why people put up with it for months — and exactly why it is worth understanding, because pain that appears with gripping and pinching is telling you where the problem sits.

The thumb carries a large share of the hand's work, and almost all of it runs through a small joint at its base. Several different structures meet there within an inch of one another: a joint that swivels, two tendons that pass through a tunnel on the wrist side, a ligament that braces the knuckle, and a pulley that guides the tendon on the palm side. Each one fails in its own way, and each one hurts in its own place.

Nitin Goyal, MD, a hand, wrist and elbow surgeon at Midwest Orthopaedics at Rush, explains the four most common reasons the thumb hurts when you grip, how the location and the trigger tell them apart, what people commonly try first, and when it is time to have a hand specialist take a look.

Where Exactly Does It Hurt? Start There

Before any test or X-ray, a hand surgeon wants to know two things: where the pain is, and what sets it off. Between them they narrow the possibilities considerably.

Where the base of the thumb is tender tells a surgeon a great deal. Pain in the fleshy heel of the thumb, low down near the wrist crease, points toward the thumb's basal joint. Pain that sits a little further toward the wrist, on the thumb side, along the bony edge where a watch strap crosses, points toward the tendons. Pain at the thumb knuckle — the joint where the thumb meets the palm — especially after a fall or a hard twist, points toward the ligament that holds that knuckle together. And a sore lump at the base of the thumb in the palm, with a catch or click when you bend the thumb, points toward the tendon pulley.

The trigger matters just as much. Jars, keys, doorknobs and pinching load the basal joint. Lifting with the thumb pointed up — a child, a laundry basket, a full kettle — and wringing or twisting motions load the tendons on the wrist side. A single hard backward bend of the thumb strains the ligament. Making a fist, or straightening the thumb after it has been bent for a while, provokes the pulley.

None of this replaces an examination, and pain from one source can spill into another. But the pattern is a useful starting point, and it is the same one a surgeon reads first.

Pain at the Base of the Thumb: Thumb (CMC) Arthritis

The thumb's basal joint — the carpometacarpal, or CMC, joint — sits where the long bone of the thumb meets a small wrist bone called the trapezium. It is shaped like a saddle, which is what lets the thumb swivel, pivot and pinch against the fingers. That freedom of movement comes at a price: arthritis at the base of the thumb is very common, and the CMC joint is the most frequent site of arthritis in the thumb.

Arthritis here is almost always osteoarthritis — the smooth cartilage that lets the bones glide wears down over time, the bones begin to rub, and the joint becomes painful. It develops gradually, and it is what patients most often mean when they describe basilar thumb pain, thumb joint pain or pain with pinching.

The pattern is distinctive. Pain sits at the base of the thumb and flares with gripping, pinching or turning — turning a key, opening a jar, twisting a doorknob, holding a pen for a long stretch. The thumb aches after it has been used for a while, and sometimes at night. Grip and pinch weaken, so lids feel tighter than they used to. The base of the thumb can be swollen and tender, and over time a bump of bone may appear there, with the thumb losing some of its range of motion.

Women are two to three times as likely as men to develop thumb CMC arthritis, and it becomes more common after 50. A family history, a past injury to the thumb or wrist, loose joints, and jobs or hobbies that involve a great deal of gripping and pinching all raise the odds. Because many people with thumb CMC arthritis also have carpal tunnel syndrome, a surgeon will often check for both.

Pain on the Thumb Side of the Wrist: De Quervain's Tenosynovitis

If the pain lives on the thumb side of the wrist rather than in the thumb itself, the likelier culprit is a tendon, not a joint. Two tendons that move the thumb — one that pulls it away from the hand, one that straightens it — travel from the forearm to the thumb through a narrow tunnel at the wrist. In De Quervain's tenosynovitis, those tendons become irritated and their sheath thickens, so they no longer glide freely through the tunnel. Every thumb movement then drags an inflamed tendon across a tight space.

The hallmark is pain on the thumb side of the wrist that is worse when the hand and thumb are in use — forceful grasping, lifting something with the thumb pointed toward the ceiling, twisting the wrist, making a fist. It can start gradually or suddenly, and it can travel up the forearm. There may be swelling over the thumb side of the wrist, sometimes a small fluid-filled cyst there, and occasionally a catching or snapping sensation when the thumb moves. Pain and swelling together can make it hard to move the wrist and thumb at all.

De Quervain's is most common in people in their 40s and 50s and affects more women than men. It is associated with pregnancy and the weeks after childbirth — new parents lifting an infant thumb-up, many times a day, is the classic story — and people with rheumatoid arthritis are more prone to it. Repetitive wrist and thumb movements such as typing, texting or lifting can make it worse, though the exact cause is not fully understood. This is the condition often labeled thumb tendonitis, and it is the one most easily confused with basal-joint arthritis, since both hurt with gripping. The separator is location: arthritis hurts in the heel of the thumb; De Quervain's hurts at the wrist.

Pain at the Thumb Knuckle After a Fall: A Sprained or Torn Ligament

The third pattern has a story attached to it. A fall onto an outstretched hand, a ski pole caught in the snow, a ball that catches the thumb and bends it back — and afterward the thumb knuckle, where the thumb meets the palm, is painful, bruised and swollen, and pinching feels weak or loose.

That is a sprained thumb, and most thumb sprains involve the ulnar collateral ligament, or UCL — a strong band on the inside of the knuckle that keeps the thumb stable when you pinch and grasp. A strong force that bends the thumb backward, away from the palm, stretches or tears it. When the injury happens on the slopes it is called skier's thumb; when the same ligament wears out gradually from repetitive grasping and twisting, the older name is gamekeeper's thumb. It is the same thumb ligament injury that sidelined Mike Trout after a head-first slide.

Sprains range from a stretched ligament to a partial tear to a complete one, and the difference matters. With a complete tear, the thumb joint may feel loose or unstable, a lump may appear on the inside of the thumb where the torn end sits, and grasping something between the thumb and index finger becomes difficult. Sometimes the ligament pulls a small chip of bone away with it. A thumb sprain that does not improve quickly should be evaluated even if it seems mild, because an unrecognized ligament tear can leave the thumb chronically unstable, weak and, eventually, arthritic.

A Lump in the Palm and a Catch: Trigger Thumb

The fourth pattern is less about pain than about mechanics, though it hurts too. The tendon that bends the thumb runs through a series of small tunnels, or pulleys, that hold it against the bone. In trigger thumb the tendon or its first pulley thickens, the tendon no longer fits, and it catches as it tries to pass — a pop, a click, or a thumb that locks bent and has to be straightened with the other hand.

There is usually a tender lump at the base of the thumb on the palm side, and pain there when the thumb bends or straightens. Stiffness and locking are typically worst first thing in the morning and ease with gentle use through the day. Most cases have no clear cause; it is more common in women between 40 and 60, in people with diabetes or rheumatoid arthritis, and in people whose work or hobbies involve repetitive gripping and pinching. Trigger thumb is easily mistaken for arthritis because both produce a sore spot near the base of the thumb, but arthritis grinds and aches while a trigger thumb catches, and trigger finger treatment is different from arthritis care.

Four Causes of Thumb Pain Side by Side

Two things do not fit this table and deserve a mention. If the thumb is numb or tingling rather than painful — particularly with the index and middle fingers, and particularly at night — the problem is more likely a nerve than a joint. Carpal tunnel syndrome is the usual explanation, and it often coexists with thumb arthritis; hands that go numb during sleep are its classic calling card. And if the whole wrist hurts and is stiff, not just the thumb side, wrist arthritis may be the better explanation.

What People Commonly Try First

For pain that has been building slowly rather than following an injury, the measures a hand surgeon usually suggests first are similar across the three non-traumatic conditions, and they follow from the mechanics above.

• Rest the part that hurts, not the whole hand. Avoiding the specific motions that provoke the pain — the jar, the lifting posture, the twisting — often allows an irritated tendon to settle and takes load off an arthritic joint. Tools that spare the thumb (jar openers, key turners, wider-grip pens) do the same job.
• A splint. A splint that supports the base of the thumb reduces pain from CMC arthritis during activities or overnight; for De Quervain's, a removable splint that keeps the wrist straight and the thumb still helps most at night. Which splint, and for how long, depends on which structure is the problem, which is one reason to have the diagnosis before buying one.
• Ice. Ice applied to the sore area for short periods, with a barrier between the ice and the skin, helps with pain and swelling.
• Anti-inflammatory medication. Over-the-counter options such as ibuprofen or naproxen, by mouth or as a topical gel applied to the joint, are commonly used; whether they are appropriate depends on your health history, so ask before starting them.

Hand therapists can also teach gentle range-of-motion and strengthening exercises for the thumb, which are better learned from a therapist than from a video, since the same movements done aggressively can aggravate a joint or tendon that is already inflamed.

A sprain after a fall is different. Rest, ice, compression and elevation are reasonable for the first day or two, but pain and swelling that persist beyond that — or a thumb that feels loose — should be examined rather than managed at home, because a torn ligament usually needs to be held still in a splint or cast to heal, and a complete tear may need repair.

When to See a Hand Specialist

Thumb pain that appears once after a heavy afternoon of gardening and clears by the next morning is rarely a cause for concern. The following patterns are:

• Pain at the base of the thumb that keeps returning with gripping or pinching for more than a few weeks, despite resting it
• Weakness — lids, keys and buttons that have become difficult, or dropping things
• Pain with visible swelling or a bump at the base of the thumb, or a thumb that has lost motion
• Any thumb pain that follows a fall, twist or blow, especially with bruising or a thumb that feels loose
• A thumb that catches, clicks or locks bent
• Numbness or tingling in the thumb and fingers, particularly at night — a sign the problem may be a nerve rather than the joint
• Pain that has stopped responding to a splint and over-the-counter measures

Injuries and instability are the ones a surgeon most wants to see early, because a ligament that heals loose is unlikely to tighten on its own.

How a Specialist Finds the Cause

A hand specialist starts with the story — where the pain is, what provokes it, whether there was an injury, what the hand is asked to do every day — and an examination of the thumb, hand and wrist. The exam locates the tenderness precisely, checks the thumb's motion and the strength of the pinch, and uses a handful of office maneuvers to sort one cause from another: holding the basal joint firmly while rotating the thumb to feel for the grinding of arthritis, folding the thumb into the palm and bending the wrist toward the little finger to load the De Quervain's tendons, stressing the knuckle to test the ligament, and watching for a catch as the thumb bends. The wrist and the carpal tunnel are examined as well, because both can accompany thumb problems.

X-rays are the usual next step when arthritis or an injury is suspected. They show narrowing of the joint space and extra bone growth in arthritis, and they rule out a broken bone or a chip pulled off by a ligament after a fall; a stress X-ray, taken while the surgeon gently loads the knuckle, can show whether the ligament is holding. De Quervain's and trigger thumb are usually diagnosed on examination alone, with imaging reserved for cases that are unclear. Ultrasound or MRI is occasionally used to judge how badly a ligament is torn.

Treatment follows from that picture. Thumb CMC arthritis can be managed without surgery in many cases with splinting, activity changes, hand therapy, medication and, for some people, a steroid injection into the joint. When those no longer work, treatment for thumb CMC arthritis may include surgery — most commonly removing the small worn wrist bone at the base of the thumb, sometimes with a tendon used to support the thumb, or in some cases replacing part of the joint with an implant — the surgical options for thumb arthritis that Dr. Mark Cohen has described. De Quervain's that does not settle with splinting is often treated with a steroid injection, and if symptoms are severe or persist, with a small procedure to open the tendon sheath and give the tendons room. A sprained thumb is held in a splint or cast while the ligament heals; a complete tear is repaired by reattaching the ligament to the bone. A trigger thumb that keeps locking is treated with an injection or a release of the pulley. Which approach fits, and whether any procedure is warranted, is a decision made with the surgeon after the examination and any imaging.

Frequently Asked Questions

What is the difference between thumb arthritis and De Quervain's tenosynovitis?

Location and structure. Thumb arthritis is a worn joint at the base of the thumb — the fleshy heel near the wrist crease — and it aches and grinds with pinching and turning. De Quervain's is an irritated tendon on the thumb side of the wrist, along the bony edge, and it hurts sharply with lifting, wringing and twisting. Both worsen with gripping, which is why they are confused. An examination usually separates them.

Can carpal tunnel syndrome cause thumb pain?

It can cause aching in the thumb and palm, but its defining symptom is numbness and tingling in the thumb, index and middle fingers, often at night. Pain that is purely at the base of the thumb with gripping, without numbness, is more typical of the joint or the tendons. Many people with thumb arthritis also have carpal tunnel syndrome, so a specialist checks for both.

Why does my thumb hurt when I text or use my phone?

Prolonged thumb use on a phone loads both the basal joint and the tendons on the thumb side of the wrist, and it can aggravate either arthritis or De Quervain's. Whether it causes a problem on its own is less clear, but if phone use reliably brings on pain at the base of the thumb, it is worth finding out which structure is complaining.

Will thumb pain from gripping go away on its own?

Sometimes. Tendon irritation often settles when the provoking activity is changed and the wrist is rested or splinted. Thumb arthritis is a wear process that does not reverse, but its symptoms can come and go, and some people find their thumb becomes less bothersome over time with or without treatment. A ligament injury is the exception: a sprain that is not recognized can leave the thumb loose and weak, so it should not be waited out.

Do I need an X-ray for thumb pain?

Not always. De Quervain's and trigger thumb are usually diagnosed by examination. X-rays are used when arthritis is suspected, to see how much the joint has worn, and after an injury, to rule out a fracture or a bone chip pulled off by a ligament. A stress X-ray can show whether the thumb's ligament is intact.

Does a splint help thumb pain?

Often, but the right splint depends on the cause. A splint that supports the base of the thumb helps arthritis pain during activity and at night; a splint that also holds the wrist straight is what De Quervain's usually needs; a sprained thumb needs a splint or cast that keeps the knuckle from moving while the ligament heals. A hand specialist or hand therapist can fit the right one.

Pain at the base of the thumb is one of the most common reasons people see a hand and wrist specialist, and it is one of the most explainable. The spot that hurts and the motion that provokes it narrow the cause before the first X-ray; the exam finishes the job, and much of what it finds can be treated.

This article is for general information and is not a substitute for medical advice. Please consult a physician about your individual situation.

Header illustration: "Hand and Wrist Bones" by BruceBlaus, via Wikimedia Commons, CC BY 3.0.

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Thumb pain that keeps coming back with gripping or pinching deserves a closer look. Our fellowship-trained hand, wrist and elbow surgeons treat arthritis, tendon and ligament problems at the base of the thumb, and the first job is finding which one is causing yours.