Wrist and Hand Pain

Wrist and hand is a complex structure made up of 27 bones joined by ligaments at various joints. Number of joints and 36 intrinsic muscles are responsible for ability to perform multiple functions due to movements in various directions. Hand pain with or without weakness and numbness can occur in nerve root compression due spondylosis of cervical spine (neck). Pain in this area can be related to occupational overuse (activities and hobbies), age, hand dominance, injury, diabetes and other endocrine disorders, pregnancy, etc. Computer related wrist and hand problems are due to repetitive work, static posture and use to too much force while using keys or mouse. Breaking up of repetitive activities, avoiding too much force, maintaining a proper posture, and avoidance of stress can prevent computer related hand problems. Early identification of the problem (pain, tingling and numbness) is essential to avoid progression of the condition.

The location, pattern, severity and type of pain are all important in diagnosis of wrist and hand disorders although this may not be easy in all cases. Arthritis of wrist and small hand joints is characterized by swelling and pain and restriction of movements. Osteoarthritis usually affects small joints at tips of finger tips. Rheumatoid arthritis affects mid-finger and finger-base as well as wrist joints and is associated with prolonged morning stiffness.

Some other important disease conditions in this region are as follows:

  1. Carpal Tunnel Syndrome Carpal tunnel, formed by wrist bones and ligaments, is a rigid tunnel at the base of hand overlying wrist. Median nerve passing through this tunnel may get compressed leading to sensory loss and pain on palmer aspect of ring and middle fingers, thumb and weakness of corresponding muscles. The initial symptoms are usually burning or tingling numbness which can disturb sleep at night. Pain may radiate up to the arm. Grip may weaken later. Few causes of carpal tunnel syndrome (CTS) include – occupational stress, injury, pregnancy, menopause, diabetes, hypothyroidism, rheumatoid arthritis and congenital predisposition. CTS is more common in women. Dominant hand is usually affected to start with. Early diagnosis is essential to avoid permanent nerve damage. Bend your hands down and press the backs of your hands over each other for one minute. This elicits finger numbness in cases of CTS. A nerve conduction test is useful for diagnosis of CTS. Treatment of CTS includes life style modification, rest, splinting and pain killers. Steroid injection at wrist is effective treatment to reduce swelling and has long lasting effects. Injections must be followed by appropriate exercise regime. The underlying condition such as hypothyroid disease also needs to be treated. Surgery may be contemplated if two or more injections fail to bring significant relief.
  2. De Quervain’s Tenosynovitis Pain and swelling of tendon along the base of thumb is known as De Quervain’s tenosynovitis (DQT). Pain may radiate along involved muscles (abductor pollicis longus and extensor pollicis brevis) in the arms. Repetitive occupational injury is the usual cause of DQT. Lifting heavy weights can also strain these muscles. Deviation of closed fist towards little finger will elicit pain in the swollen area. Rest, splintage (especially during work) and pain killers relieve pain to certain extent. Local injection of steroid is useful in most cases. Surgical release is rarely required and may be done in refractory cases.
  3. Ganglion ganglions are most common soft tumors of hand. Small to medium sized lumpy swelling under the skin at the back of wrist arises from tendon sheath or joint. Small ganglion cysts may also appear on fingers. Ganglions are filled with thick jelly like fluid similar to joint fluid. They can be soft or firm and are usually painless. Smaller ganglions cause more pain. A tight wrist brace may decrease size of the swelling. Aspiration of swelling with a large bore needle and followed by injection of steroid is the treatment of choice. Surgery is indicated for refractory painful ganglions and for cosmetic reasons.
  4. Trigger Finger A thickened tendon sheath prevents gliding of finger tendon within and leads to trigger finger. The finger or thumb locks when flexed which is followed by release like a trigger. The cause of trigger finger is not known and is believed to be due to repetitive trauma. The problem can be due to localized swelling or a nodule over the tendon itself. The problem can be demonstrated by clenching fist and opening the fingers. Trigger finger does not open up easily and may have to be straightened manually. A tender nodule may be palpable at base of the finger over the palm. Local steroid injection relives the problem for many months in about 50% cases. Injection may be repeated in cases of recurrence. Surgical intervention is indicated in severe cases with painful locking and in those with failure of local injections.
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