Adductor Pollicis Trigger Points

Introduction

The adductor pollicis is a deep hand muscle responsible for thumb adduction and grip strength. When trigger points develop in this muscle, they can cause pain in the thumb, palm, and wrist, often mimicking conditions like carpal tunnel syndrome or arthritis. Proper identification and treatment of these trigger points can relieve discomfort and improve hand function.

Name and Area

  • Name: Adductor Pollicis

  • Area: Located in the hand, forming part of the thenar eminence, with two heads:

    • Oblique Head: Runs diagonally from the capitate and second and third metacarpals.

    • Transverse Head: Runs horizontally from the third metacarpal to the base of the thumb.

Indications

Adductor pollicis trigger points may contribute to:

  • Thumb Pain and Stiffness

  • Pain in the Webbing Between the Thumb and Index Finger

  • Pain That Radiates to the Palm or Wrist

  • Weakness in Grip Strength (Difficulty Pinching or Holding Objects)

  • Cramping or Fatigue in the Thumb During Repetitive Use

  • Discomfort When Pressing the Thumb Against the Palm

Pain is often mistaken for arthritis, tendonitis, or nerve compression syndromes.

Muscle Action

  • Thumb Adduction: Moves the thumb toward the palm or index finger.

  • Pinch Grip Strength: Helps with grasping small objects, writing, or holding a phone.

  • Power Grip Contribution: Assists in holding larger objects, such as a tennis racket or hammer.

The adductor pollicis is essential for dexterity and fine motor control.

Signs and Symptoms

Individuals with adductor pollicis trigger points often report:

  • Pain at the Base of the Thumb, Extending Into the Palm

  • Tenderness in the Webbing Between the Thumb and Index Finger

  • Difficulty Holding Small Objects (Pins, Pens, Coins, or Needles)

  • Weak or Painful Pinch Grip (Buttoning a Shirt, Using a Key, or Opening Jars)

  • Aching Sensation That Worsens With Repetitive Thumb Movements

Pain worsens with prolonged gripping, pinching, or activities requiring thumb precision.

Perpetuating Factors

Common causes of adductor pollicis trigger points include:

  • Repetitive Hand Use (Typing, Writing, Gaming, Playing Instruments, Texting)

  • Forceful Pinching (Holding Tools, Scissors, or Tweezers for Long Periods)

  • Tight Gripping (Rock Climbing, Tennis, or Weightlifting Without Proper Hand Rest)

  • Thumb Overuse From Touchscreen Devices (Excessive Scrolling, Swiping, or Texting)

  • Poor Ergonomics in Workspaces (Incorrect Keyboard or Mouse Positioning)

  • Wearing Gloves That Are Too Tight (Restricting Natural Thumb Movement)

Trigger Point Referral Pattern

Trigger points in the adductor pollicis refer pain to:

  • The base of the thumb

  • The webbing between the thumb and index finger

  • The center of the palm

  • The wrist (Can Mimic Carpal Tunnel Syndrome)

Pain often intensifies when gripping, pinching, or pressing the thumb against the palm.

Differential Diagnosis

Adductor pollicis trigger points may be mistaken for:

  • Carpal Tunnel Syndrome (Wrist and Thumb Numbness/Tingling)

  • De Quervain’s Tenosynovitis (Pain in the Thumb Extensors Near the Wrist)

  • Arthritis at the Thumb Base (CMC Joint Osteoarthritis)

  • Trigger Thumb (Clicking or Locking Sensation in the Thumb Joint)

  • Median Nerve Compression (Causing Thumb Weakness and Pain)

A thorough hand and thumb examination is essential for correct diagnosis.

Associated Trigger Points

Adductor pollicis trigger points often co-exist with:

  • Flexor Pollicis Longus (Pain in the Thumb and Wrist)

  • Opponens Pollicis (Reduced Thumb Mobility and Weakness)

  • First Dorsal Interosseous (Pain Between the Thumb and Index Finger)

  • Extensor Pollicis Longus/Brevis (Pain and Weakness in the Thumb and Wrist)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Adductor Pollicis (Oblique Head) Capitate, second and third metacarpals Base of the proximal phalanx of the thumb Ulnar nerve (C8–T1)
Adductor Pollicis (Transverse Head) Third metacarpal (shaft) Base of the proximal phalanx of the thumb Ulnar nerve (C8–T1)

Unlike many thenar muscles controlled by the median nerve, the adductor pollicis is innervated by the ulnar nerve, affecting grip strength and precision movement.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules at the base of the thumb and in the webbing between the thumb and index finger.

  • Grip Strength Testing: Assess pain and weakness when pinching or gripping objects.

  • Thumb Adduction and Opposition Testing: Evaluate the ability to press the thumb firmly against the index finger or palm.

  • Thumb Fatigue Assessment: Check for cramping or discomfort after prolonged hand use.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply firm pressure to the thumb webbing and palm.

  • Deep Tissue Massage: Focus on releasing tight fascia in the thenar eminence.

Stretching

  • Thumb Web Stretch: Gently pull the thumb away from the hand and hold for 20–30 seconds.

  • Palm and Finger Stretch: Open the hand wide and spread the fingers apart to stretch the thenar muscles.

Strengthening Exercises

  • Thumb Adduction Against Resistance: Use a rubber band or therapy putty to strengthen the adductor pollicis.

  • Pinch Grip Exercises: Hold small objects like coins, marbles, or clothespins to improve grip endurance.

Postural and Ergonomic Adjustments

  • Modify Hand Positioning When Typing or Using a Mouse

  • Use Larger Hand Tools to Reduce Thumb Strain

  • Take Breaks During Repetitive Hand Tasks

Field Details
Name & Area Adductor Pollicis; Thumb, palm, and hand
Indications Thumb pain, grip weakness, palm and wrist discomfort
Muscle Action Thumb adduction, pinch grip strength, power grip support
Signs & Symptoms Pain at the base of the thumb, cramping in the palm, weak grip strength
Perpetuating Factors Typing, texting, pinching, gripping, tight gloves, poor ergonomics
Trigger Point Referral Thumb webbing, palm, wrist
Differential Diagnosis Carpal tunnel, arthritis, trigger thumb, De Quervain’s tenosynovitis
Associated TrPs Flexor pollicis longus, opponens pollicis, first dorsal interosseous
Anatomy & Innervation Ulnar nerve (C8–T1)
Corrective Actions Manual therapy, stretching, strengthening, ergonomic adjustments

Summary Table: Adductor Pollicis Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.