September 2, 2013
Pain Between the Thumb and Index Finger
Ache experienced in the first dorsal web space of the hand, i.e. the area between the thumb and the index metacarpal, is not a common complaint. Once arthritis and ulnar nerve entrapment have been excluded the pain occurring in this area may be related to muscle activity resulting in elevated pressure in this muscle compartment.
I am only aware of three references to dynamic first dorsal interosseous compartment syndrome in the literature. All three reports occurred within four years of one another in the Journal of Hand Surgery.
Diagnosis of First Dorsal Web Space Pain
The diagnosis can be made with intracompartmental pressure measurement as is done for other sites for compartment syndrome with a wick catheter or Stryker device. A. Lee Dellon reported the use of a stress test he used in one patient monitoring key pinch for weakening with repetitive pinching in association with the development of first dorsal interosseus area pain.
Treatment of Pain Between Thumb and Index Finger
The pain resolved with surgical decompression and the pinch strength was regained, I have no personal experience in seeing anyone with this diagnosis, but as with other rare entities, one must maintain an open mind when establishing a differential diagnosis.