Treating the Intrinsic Muscles of the Hand - Dr. Jonathan Kuttner
Painful conditions of the hands are on the increase. This is at least partly attributed to the rapid spread of hand-held devices such as smart-phones and tablets.
A painful thumb, fingers or hand can be pretty uncomfortable and debilitating and clients often assume that they are suffering from some form of arthritis or the well-known carpal tunnel syndrome.
In fact, many of these cases are related to trigger points that can be quite easily treated.
Common Trigger Point Sites - Adductor Pollicis (A), Opponens Pollicis (B)
About these Muscles
Adductor: Brings thumb back to palm from abduction. Opponens: Draws the thumb towards the fingers so that the thumb tip can touch any fingertip.
Trigger Points in these muscles can usually be treated quite easily - pressure tools are recommended.
Trigger points in these small muscles of the hand cause their characteristic pain patterns (see illustrations below), along with clumsiness of the thumb, and a great deal of misunderstanding concerning the attention and care of the owner of that thumb.
The ability to catch, grip and pinch may be compromised or lost. Tasks requiring agility and control—such as buttoning, writing, typing, and operating machinery—become difficult and frustrating because of muscle weakness and loss of fine motor control.
It's worth noting that that the opponens muscle itself is often free of pain, yet that area must be treated.
The three muscles that make up the thenar eminence are tightly bound together by fascia, and that fascia is tough. The opponens pollicis is covered by the abductor pollicis brevis and often partially fused with the flexor pollicis brevis.
Palpation of the opponens pollicis is difficult, but don’t be dismayed—you can treat them all at once!
Notable Perpetuating Factors
Any pincer-type motion, such as weeding, sewing, opening jars, writing, texting, video gaming, computer keyboarding, or handcrafting, and any task involving excessive or repeated thumb pressure.
Adductor Policis - Typical Pain Pattern
Opponens Policis - Typical Pain Pattern
General Advice for Patients
Avoid rotational stress to the wrist such as that caused by repetitive use of a screwdriver. Pace tasks that use similar motions. Use the opposite hand when possible, and modify, delegate, or delete tasks when life allows.
Avoid persistent grasping and pulling motions such as vigorous weeding or even use of your mobile phone. Try switching hands when using and operating your mobile or tablet device.
Not that anyone seems to do too much writing nowadays, but if you do, use a soft tipped pen for writing, and take regular breaks. These trigger points will respond well to stretching, manual therapy, and the use of pressure tools can be very effective.
General Advice for Therapists and Care Providers
These trigger points are especially common in clients who have previously suffered from a fracture.
Stretching, especially spray and stretch can be very effective (see below).
Opponens Pollicis Trigger Points - use one hand to stretch the opposite thumb. This is a recommended general stretch for anyone working with their hands.
A simple self-stretch for the opponens pollicis can be done using one hand to stretch the opposite thumb.
Keep the fingers of the involved hand flat, and stretch the involved thumb gently through range of motion until you feel the first sense of bind then return to start and repeat.
An easy self-stretch for the adductor pollicis involves filling a basin with moderately warm water and pressing the hand palm down with thumb and index finger widely spread on the bottom of the filled basin.
As with all stretching, the idea is to avoid unduly stressing the tissues while encouraging normal range of motion.
Recommended Starter Packs:
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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