Ep 429 -The Thumb: The Rogue Digit:"The Rebel MT"with Allison Denney

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0:01:46.1 Speaker 2: Have you ever heard of a guy wire or a guy line or a guy rope? No, not a guy like a dude. A guy Wire is a tensioned cable designed to add stability to a free standing structure. So like for a mast of a sailboat or a utility pole or a wind turbine. Guy wires are set up so that one end is attached to the structure and the other end is anchored to the ground. And there are often multiple guy wires attached to said structure in an effort to stabilize the standing object. Hello engineering meet anatomy. The thumb in its endless effort to break free from the rest of the digits is a free standing pole for all intents and purposes. And the muscles that move it and also endlessly try to stabilize it are very similar to guy wires. This is a great way to think about the thumb because there is a lot going on here and it can seem very confusing when we start learning about it.

0:02:48.0 S2: The bits and pieces that are involved in thumb anatomy and the actions the thumb have can seem complicated. But how complicated, exactly? Let me count the ways. There are nine muscles that move the thumb. Well, nine plus seven 'cause there are seven movements of the thumb. So that's sixteen. I mean nine plus seven plus 12 'cause there are 12 bones involved in thumb movement. The radius, the ulna, five carpals, three metacarpals, and two phalanges. So twenty eight we could add in the ligaments and nerve and blood vessels, but for the sake of brevity and everyone's sanity, let's stop there. So there are 28 ways in which the thumb is complicated and for even more sanity, I am not going to go into detail with origins and insertions of each of these muscles 'cause that would eat up about 35 hours or so. So for this episode, let's count the nine guy wires or muscles and seven movements that those guy wires dictate and let's uncomplicate them.

0:03:46.9 S2: If we look at the thumb and compare it to our other digits, there are a couple of big differences to notice right off the bat. First it is shorter and second, it moves differently. It's like a finger that has gone rogue and has had some rough run-ins along the way. It's shorter because it has two phalanges as opposed to the three that the longer fingers boast. So it can't quite curl into a deep flex like the fingers can, but it makes up for that in droves with its other movements. These movements as all joint movements do really stem from the muscle attachments onto the bones, pulling it this way and that. And some of those bones are, as I mentioned earlier, five of the eight carpals. More specifically, these are the scaphoid, trapezium, trapezoid, capitate and lunate. I recommend giving those a once over in your anatomy books or apps or what have you, just to keep familiar with them.

0:04:42.9 S2: But they are all located in the middle and radial side of the wrist and slide around each other to get that thumb to do its crazy thumb tricks. Enough about bones. What does the thumb do? This is a good anatomy party trick. The fingers seem to fall in line with the big actions we learn in school. They flex curling into the hand extend, straightening back out, abduct pulling away from each other and abduct moving back next to each other. The thumb though seems to operate on a different plane. That's because it is on a different plane. And this, my dear thumb enthusiast is the first trick to getting those actions down. Hold your hand up and turn your palm towards you. So you are looking at it. Keep your fingers straight and together. Now pull your thumb towards you. Now find a wall and hold your hand to the wall so that the side of your first finger and back of your thumb are against the wall.

0:05:35.7 S2: The rest of your hand should be making a right angle coming away from the wall. Palm still facing you. The whole right angle thing is important here. Your hand lives and moves as it is oriented in one plane and your thumb moves as it is oriented in another. And these two intersect at a right angle. So if you hold your hand out and open up all of your fingers and your thumb as if you were trying to tell someone across the room that you'll be off the phone in five minutes. Your fingers may be abducting but your thumb is extending weird. Kinda, but kind of not once you see the different planes starting from that original position, using the wall to keep your thumb in its own plane, pulling your thumb along the wall towards you is going to be abduction. 'cause this is how you pull the thumb away from the midline.

0:06:23.4 S2: See that webbing between your thumb and your first finger? If that looks smooth, this means you have successfully performed thumb abduction. This would also mean that pulling it back into place would be abduction. Adding it back to the midline. Flexion then would be pulling it away from the wall. Kind of like if you tried to touch the base of your thumb with your thumb pad and then straightening it back out, of course would be extension. The tricky thing about extension is that it is the action and not so much the position really. So like I mentioned earlier, holding your hand up indicating to someone across the room that you'll be off the phone in five minutes. Your thumb is technically in extension and this position of extension can be pulled away from your fingers, but this is not abduction. A good way to remember this is to check that webbing between your thumb and your first finger.

0:07:14.8 S2: Again, if it is wrinkled and folded up a bit, this is extension and then there is opposition. The movement that a lot of us have thought for a long time set us apart from the rest of the animal kingdom. Turns out it's more about our complex brains and not so much about our complex thumbs, but this action is very cool. Pulling your thumb into opposition is a little flexion mixed with a little rotation. It is the action that drives your thumb across your palm to touch another finger and creates a little cup in your palm when you do it. You can see this most exaggeratedly when you reach the tip of your thumb to touch the tip of your pinky. That cup in your palm and the incredible muscles that make that happen give us the ability to grip things. And this simple act gives us the power to do so many things like massage another human's thumb.

0:08:04.0 S2: The opposite of opposition then would be reposition. Bringing your thumb back against the wall is repositioning it back into place. This is where things get really funny because for the most part, the muscles that move the thumb are named such because of the actions they perform. For example, the abductor pollicis brevis located at the most lateral aspect of the thenar eminence. The thick padded part of your palm at the base of your thumb is going to abduct your thumb. Just medial to that into the belly of the thenar eminence a bit lies the flexor pollicis brevis, which as you may have suspected will flex the thumb. Side note, both of these muscles have the word pollicis in them because pollicis means thumb. And both of these muscles have the word brevis in them because they are the shorter of two muscles that also have a longer version, in which case the word brevis gets swapped out for the word longest.

0:08:53.0 S2: There is even an opponens pollicis muscle, which well, you know what that does. There is not though a reponens pollicis muscle to be found that repositions the thumb back, nor is there a retropulsion pollicis. Yep. Just because anatomy likes to keep you on the edge of your seat, there is one more action of the thumb retropulsion. If you take your hand away from the wall and place it palm down on a table and then lift your thumb up off the table. This is known as retropulsion. It also appears to be the thumb version of hyperextension, but as we have already noted, the thumb has gone rogue. Neither retropulsion nor reposition have muscles aptly named. They are an extra energy pole from the extensor lysis longest and brevis muscles, which are mostly famous for the tendons that pop up at the back of your thumb when they are tugged at creating the ever loved anatomical snuffbox.

0:09:49.5 S2: I couldn't make a podcast about the thumb and not mention the anatomical snuffbox. So we have the actions, flexion, extension, abduction, abduction, opposition, reposition, and finally retropulsion. And the muscles that move them for the most part are named for the movements they create. And if they come in pairs, there is a longus and a brevis. But a better way to think about these is to picture those guy wires. There are some that are smaller and closer to the structure and there are some that are longer and farther away from the structure. In engineering this creates a cool lattice component to keeping things stable. In anatomy, it does the same thing. We call the smaller and deeper guy wires intrinsic and the longer more superficial guy wires extrinsic. And when we name them, we use the terms brevis and longus. The extrinsic muscles as they are longer all live in the forearm.

0:10:40.7 S2: They include the extensor pollicis longus, the flexor pollicis longus, the abductor pollicis longus, and just to mess you up, the extensor pollicis brevis because it is short but not that short. The intrinsic muscles include the abductor pollicis brevis, the flexor pollicis brevis, and the opponent's pollicis combined these muscles make up the thenar eminence. If you're good at math though, or have been keeping track, this totals seven muscles. I mentioned at the beginning of this episode that there are nine and right you are. There are two more thumb muscles that are even deeper. Think of these like you might consider the rebar that really holds a structure in place only with a little allowance of movement. Of course, these are the adductor pollicis and the first dorsal interosseous muscles. They both adduct the thumb and because of their depth and positioning, they are strong thumb stabilizers, which we need because we have thumbs getting a grip on what the thumb is.

0:11:39.8 S2: A pole with fancy named guy wires or a rogue finger that lives in its own reality is undoubtedly the first step in upping the work you do with this funny piece of anatomy. We use and abuse our thumbs on a regular basis, not just us massage therapists and body workers, but us humans as a whole. Gripping and grabbing is quite literally an essential piece of our identities. Tape your thumb to your hand for a day and discover how much we really rely on it. And then enjoy your thumb a little more when you take that tape off. Keep all of these elements in the forefront of your mind as you approach the numerous thumbs you will manipulate throughout your career. This is the kind of attention to detail that your clients will notice.

0:12:32.3 S2: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M T@abmp.com. I always wanna hear your questions, comments, suggestions, or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there and other rebel massage dabblings.

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