What is Texting Thumb?

Have you heard of "texting thumb?" Turns out, your thumbs and your smart phone may have an unhealthy relationship.

Last year, adults in the U.S. spent an average of 3 hours, 35 minutes per day on their mobile devices, an increase of more than 11 minutes over 2017, which adds up to an incredible 1500+ hours per year. That’s the equivalent of 62 days spent on a mobile device in one year. Two months. And that’s the adults. For young people, it’s much more.

According to Common Sense Media, teens spend an average of nine hours a day online, compared to about six hours for those ages 8 to 12. That translates into about 137 days per year for teens, and 91 days a year for 8- to 12-year-olds. That’s a lot.

So much phone time can have a direct (and sometimes, even painful) impact on one of the body’s most versatile and useful appendages, the humble thumb. If your thumb joint hurts, odds are good that it’s osteoarthritis of the basal joints of the thumb, otherwise known as texting thumb.

Thumbs the Word

Dr. Ghazi M. Rayan is an orthopedic and hand surgeon. He is also a clinical professor of orthopedic surgery, adjunct professor of anatomy and the director of the Oklahoma Hand Fellowship Program at INTEGRIS Baptist Medical Center in Oklahoma City. Over the course of his decades-long career, he has performed more than 25,000 surgeries including those to repair osteoarthritis of the thumb, aka arthritis of the basal joints of the thumb. “And for every surgery performed, I’ve helped more than a dozen patients non-surgically,” he says.

The thumb is a wonderfully complex apparatus. "A typical joint is formed by two bones that are connected together with ligaments, which provide joint stability. The joint is surfaced by thick cartilage, which acts as a cushion and allows smooth joint motion between the bones," Dr. Rayan says. He explains that there are 360 joints in the human body, and 19 of those joints are just in the hand. Of those, there are three bones and three joints in the thumb.

“The anatomy of the thumb basal joint is the most complex of all hand joints. The thumb allows motion on three planes and circular movement, which means the thumb provides opposition, which is unique to humans.”

Because the thumb is so mobile and is stabilized largely by ligaments, which can be stretched causing destabilization, placing repeated or near-constant pressure on the thumb is a recipe for thumb pain, inflammation and eventually arthritis.

Think of it this way — one pound of force at the tip of your thumb while pinching is magnified exponentially and becomes three pounds at the first joint; six at the second and 12 at the basal joint. A pinch of 20 pounds at the tip translates to 240 pounds of force at the basal joint of the thumb.

These forces cause the ligaments of the joint to stretch, which results in joint instability. When a joint is unstable, it can cause repetitive-use trauma, or a ligament can tear. Joint instability is a prelude for arthritis because the abnormal motion gradually wears away the joint cartilage and in severe cases you will have bone against bone. There are no nerve endings in cartilage, but there are plenty in bone.

Osteoarthritis of the thumb has three general stages. In the early-stage there is joint instability; by the intermediate stage there is moderate joint disease; and at the advanced stage there is severe joint destruction.

The symptoms of osteoarthritis of the thumb can be debilitating, and can include pain, stiffness, swelling and loss of strength of the thumb. These symptoms occur in remissions and relapses but during relapse they can adversely affect the ability to use the hand.

Dr. Rayan reports seeing at least three times as many cases of osteoarthritis of the thumb today compared to 20 years ago, and he expects the trend to continue. But no matter how far down that road you may find yourself, there are treatment options that will help, and which may mitigate your pain and damage.

Treatment for Texting Thumb

Dr. Rayan says that vitamins and supplements are not useful and not scientifically proven to alter the course of the disease.

In early stages, in his practice, initial treatment is always conservative and includes modifying activities, splinting, and non-steroidal anti-inflammatory medications. Under certain circumstances local steroid injection of the joint may bring about temporary pain relief.

For those with advanced-staged osteoarthritis of the thumb, patients with low physical demands are offered non-operative treatment. For other patients, non-operative treatment may only delay the need for surgery. “If these non-operative measures fail or the patient has severe symptoms that are affecting his or her ability to use the hand in activities of daily living and function there are surgical options that are proven effective in relieving pain,” Dr. Rayan says.

“Surgery is always a last resort,” he says. “If there is joint instability, stabilization by reconstructing the ligaments can be done, which is not an involved surgery, aimed at restoring joint stability. It relieves pain but most importantly may slow down or inhibit the disease progression.” The two surgical options are joint fusion or joint reconstruction.

Joint fusion is suitable for younger patients with high physical demands and totally eliminates the joint and its motion.

Joint reconstruction is the most widely used surgical technique. While it can come in the form of implants or artificial joints, both of those have increased risks for complications, such as implant instability, implant breakage, displacement and joint deterioration.

Dr. Rayan prefers to reconstruct joints using a patient's tissues. “The most widely used method is a physiologic and simple reconstruction using a patient’s own tissues to remove the arthritis and stabilize the joint. Soft tissue reconstruction is the most widely used method. In the hands of a trained hand surgeon it is safe, effective and offers the best outcome,” Dr. Rayan says.

If you are in need of a hand surgeon, the INTEGRIS Hand and Microsurgery Center at INTEGRIS Baptist Medical Center in Oklahoma City is dedicated to providing excellent medical and surgical care for patients with hand, wrist and upper extremity diseases and injuries.