Hand pain and causes

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Many types of conditions affect the hand and cause pain. Arthritis is one of the most common causes of hand pain. The hands, according to one expert, are really the mirror of arthritis. The most common type of arthritis that affects the hands is osteoarthritis.

This causes knobby bony swelling in the distal row of finger joints. These are called Heberden’s nodes. The bony swellings that affects the more proximal row of finger joints are called Bouchard’s nodes.

Gout causes deposits of uric acid to accumulate in finger joints. These deposits, called tophi, can lead to joint swelling and pain and be mistaken for other types of arthritis.

Pseudogout can also affect the hands. It is often confused with rheumatoid arthritis.

Psoriatic arthritis causes inflammation and swelling of fingers, particularly the tendon sheaths. The fingers can look like sausages.

In rheumatoid arthritis, the hands and the wrists become involved, leading to contractures and deformities. The most effective prevention for this is early and aggressive treatment. In combination with drug therapy, occupational therapy can be extremely beneficial to the patient.

Patients can benefit from home paraffin treatments. Custom dynamic splinting can be used to improve activities of daily living.

Autoimmune disease such as systemic lupus erythematosus, progressive systemic sclerosis, and dermatomyositis may affect the hands with swelling and inflammation involving the fingers.

De Quervain's tenosynovitis is inflammation of the tendon on the side of the wrist at the base of the thumb. This tendon is the extensor pollicus longus tendon. De Quervain's tenosynovitis causes pain and tenderness at the side of the wrist next to the base of the thumb. Sometimes there is slight swelling and redness in the area.

De Quervain's tenosynovitis may be caused by repetitive activity which involves pinching with the thumb while moving the wrist. Treatment usually involves taking non-steroidal anti-inflammatory drugs, a cortisone injection administered using ultrasound guidance, and splinting. Surgery is rarely needed.

The carpal tunnel is a narrow passage into the wrist, formed by bones and ligaments which shield the nerves and tendons that travel into the hand. Symptoms of carpal tunnel syndrome (pain, numbness, and tingling in the hand and wrist) occur when tissues inside the carpal tunnel become inflamed and swollen and press on the median nerve.

The American Academy of Orthopedic Surgeons (AAOS) as part of the Prevent Injuries America Program urged that prevention is a first line of defense against carpal tunnel syndrome. Specifically, the AAOS offered the following advice:

  • Avoid activities requiring excessive up-and-down and side-to-side movements of the wrist.
  • Position and align your hands properly while working. Wrists should be parallel and elbows should be at a 90 degree angle to your work surface (i.e. desk or keyboard).
  • Take frequent breaks to stand, walk, and stretch.
  • Ask your physician about splints to limit wrist movement.
  • Avoid direct pressure on the heel of the hand.
  • Don't wear restrictive watchbands/jewelry or clothing with tight elastic sleeves.
  • Learn proper use of the computer mouse. (Use the mouse with an open, relaxed hand posture. Don't grip the mouse between the thumb and little finger. Use the entire arm to move the mouse as opposed to shifting it with a side-to-side wrist motion. Do not use a wrist rest. Keep the mouse close to the keyboard.)

The treatment involves splinting ultrasound guided steroid injections, as well as ultrasound guided needle carpal tunnel release, which is a new procedure with excellent results. In patients who fail this set of techniques, surgery is sometimes required. Surgery is done endoscopically in most cases.

Arthritis at the small joint at the base of the thumb is a frequent condition, which causes annoying symptoms which can impair both strength and function of the hand. The condition occurs most commonly in women over the age of 40 and often affects both hands.

Arthritis of the thumb is a form of osteoarthritis. It affects the basal joint of the thumb, formed by the thumb metacarpal bone and a wrist bone called the trapezium. The ends of these bones are covered with cartilage, which acts as a cushion and allows them to move freely. When the cartilage wears away, the joint becomes inflamed.

Patients developing arthritis at the base of the thumb usually first notice pain associated with pinching activities such as turning keys or opening car doors. Tenderness in the fleshy thumb muscle over the first metacarpal or at the top of the basal joint may also be experienced and there may be an aching discomfort at the base of the thumb following heavy use or with weather changes.

The patient will often avoid using the thumb for those activities that produce pain and over time this disuse can lead to weakness, muscle loss and a tendency to drop things.

A diagnostic maneuver known as a "grind test" or "torque test" is sometimes used on physical exam. In this test, the first metacarpal is grasped, pushed downward and rotated. Pain and a crunching or gritty sensation during this maneuver usually indicate that at least some degree of arthritis is present.

In the early stages of arthritis at the base of the thumb, anti-inflammatory medication, cortisone injections into the joint, or splinting of the wrist and thumb may be helpful. Splints will put the thumb at rest and prevent the arthritic joint from moving. This may provide relief from the symptoms.

It is important that the splints used for this condition extend well up on the thumb. Most commercially available, "drug-store" wrist splints leave the thumb free and may actually worsen the discomfort at the base joint. When these conservative methods of treatment are no longer beneficial to the patient, surgery may be warranted.

Arthroscopic debridement followed by injection of a viscosupplement has been used with success at the Arthritis Treatment Center.

Surgery is reserved for advanced disease. Surgery is accomplished by one of several techniques, which remove the destroyed joint surfaces, and create a substitute joint. The procedure is referred to as an arthroplasty.

In general, all techniques involve removing the trapezium. In most cases, the space created by removing the trapezium will be filled with tendon material, and most surgeons use all or part of an adjacent tendon to suspend and stabilize the base of the first metacarpal.

Strength recovery may take up to one year.

Trigger finger (stenosing tenosynovitis) is a "snapping" of any of the digits of the hand when opened or closed. Trigger finger can affect the thumb.

Trigger finger is caused by local swelling from inflammation or scarring around the tendons that normally pull the affected digit inward toward the palm (flexion). Sometimes trigger finger occurs with an associated condition such as rheumatoid arthritis.

Stretching, ice, and anti-inflammatory drugs can be helpful. Most patients respond to a local cortisone injection around the affected tendon. When trigger fingers persist after two injections and are not responsive to the above treatments, ultrasound-guided hydrodissection of the tendon sheath can be curative. Surgery is rarely required.

Painful and deformed small joints can be helped by implant replacement.

The small joint implant was developed by Alfred B. Swanson, M.D., an orthopedic hand surgeon from Grand Rapids, Michigan.

Since full function is not restored, finger implant surgery is not considered the first choice of treatment. More conservative measures to diminish pain and restore function are encouraged prior to considering surgery including exercise, assistive devices including splints, hot and cold treatments, and medications.

The surgery is most valuable for patients who will regain function and who will benefit greatly from achievable pain relief.

Infections of the hand such as cellulitis may occur after animal or human bites. These are very painful. Since the hand is made of many compartments, infection may spread rapidly and must be treated aggressively with antibiotics and possibly drainage procedures. Patients who are immunocompromised (diabetes, cancer, etc.) are at particular risk.

For more information about tendonitis of the hand, visit our sister site: Tendonitis And PRP

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