Texting Thumb "Mommy's Thumb"
Texter's thumb is the newest name for tenosynovitis of a group of extensor tendons that control the thumb. It also known as "Mommy Thumb", "Gamer's Thumb", and Dequervains Disease, named after the Doctor who originally described the disorder in surgical literature.
It affects mainly teenagers, but with the massive growth and commonality of cell phone users, this is also now seen in all walks of life.
As opposed to the constant positioning of the wrist in flexion when mothers feed their babies, gamers usually submit the tendons of their thumbs to long period of high speed repetitive motion without rest.
This results in the onset of inflammation and swelling, not only in the wrist, but also in the flexor tendon to the thumb.
Treatment with splinting is usually unsuccessful, because the patients have to sacrifice dexterity when operating their hand controls, so compliance, especially in teens, is poor.
The most recommended initial treatment is obvious, TAKE A BREAK FROM GAMING!
Rest will often allow for recovery, but is usually futile from a long term prospective, because few patients are willing to give up this lifestyle in the near future.
Steroid injections can also be very effective, even in those patients who insist to continue their habits.
Surgery is probably the only reliable cure other than cessation or drastic reduction in the duration and frequency of gaming sessions. It entails releasing the tendon sheath of the first extensor compartment.
Mommy thumb is the newest nick name for a condition caused by tendonitis. It is also known as "Texter's Thumb".
The disorder is also known as "DeQuervain's Disease" named for the person who first described the disorder.
Holding the wrist in a flexed or abducted position while holding the thumb outward puts a strain on the Abductor Pollicus Longus tendon as it exits the First Extensor compartment. Instead of the tendon being able to glide in a straight line, it is forced into a right angle as it exits the sheath. This eventually l gets very inflamed and swollen, making it more and more difficult to glide without friction. Since the sheath it exits is a very rigid inflexible structure, it becomes more and more painful for the tendon to glide appropriately.
Treatment is based on one of two goals: either make the tendon swelling go away, or make the passageway larger, so there is less friction.
Injections of the sheath with steroid solution works very well in the majority of cases; even the more severe and chronic ones.
At the Thumb Specialty Center, we have approximately a 70% success rate with injections alone.
In those cases where the pain returns, a second injection can also result in a 70% likelihood of success. Hence it is only necessary to operate on 9% of the patients we see.
Surgery is a very straightforward process where the tendon sheath is opened along one side to allow for an increase in diameter. The long term results are excellent, but occasionally, the tendon can slip out of the sheath where it has been opened. It can be a painful experience, and is usually only treatable by repeating surgery to repair the sheath in some fashion.
At the Thumb Specialty Center, we prevent this complication by two methods:
- A zig-zag incision is made at the outlet when the sheath is opened. This creates two triangular flaps that can be sewn together, effectively repairing the sheath in a fashion that increases its diameter permanently.
- Splinting the wrist in a neutral position for 2 weeks after surgery allows the patient to use his thumb, preventing scarring and adhesions between the tendon and surrounding structures.
In Dr. Coleman's 26 year experience, there has never been a recurrence of pain or slipping of the tendon out of its sheath.