Hand and wrist pain

The hand and wrist are made of many small joints, which allows precise movements. They are exposed to numerous overloads and injuries, they can also be attacked by inflammatory diseases. In addition to the joints themselves, the cause of the pain may be diseases of other structures, e.g. tendons, nerves and muscles.

What are the causes of hand and wrist pain?

Osteoarthritis of the hand joints – a common disease affecting mainly people over 40 years of age. An important role is played by family predisposition as well as exposure to repeated micro-injuries (eg related to work or sports and recreational activity). Pain and stiffness usually concern the proximal and distal interphalangeal joints, as well as the thumb base. Ailments increase with movement and decrease at rest, although in exacerbations of the disease may occur all the time, also at night. As a rule, after the period of exacerbation of the disease (caused by a change in the structure of the joint and the formation of degenerative nodules – the so-called Heberden and Bouchard nodules). Unfortunately, it is not possible to effectively prevent the degenerative changes in hands, but you can alleviate the associated discomfort. These changes are often accompanied by degenerative changes in the knee joints.

Inflammatory joint diseases such as rheumatoid arthritis or psoriatic arthritis – apart from pain, there is swelling in the joints and characteristic morning stiffness (lasting over an hour, which subsides after flare up). As a rule, other symptoms of the disease also occur, including weakness, feelings of disintegration and low-grade fever. Inflammatory joint diseases start at different ages, usually between 30 and 50 years of age.

Inflammation of the flexor tendon of the finger flexor – a common cause of finger pain and bending problems. It results mainly from repeated microdamages (eg professional, sports), less often is a consequence of infection or other joint disease. Enlargement of the sheath surrounding the tendon makes it difficult to slip during movement and even causes the finger to lock in the flexion (the so-called snap-on finger).

Carpal tunnel syndrome – a common disease that especially affects people with degenerative hand disease, rheumatoid arthritis and diabetes, as well as pregnant women. Symptoms are caused by the compression of the median nerve running in the wrist canal. Patients complain of the feeling of suffering, tingling and burning pain of the first four fingers (thumb, index finger, middle finger and ring finger), intensified especially at night or when bending the wrist. Ailments can be very onerous, awake from sleep and disrupt the daily activities. In the advanced form of the disease, muscle womb and sensory disorders disappear. Similar symptoms may also occur in the case of cervical spine disease or median nerve compression at a higher level. It is important to have an early diagnosis and proper treatment to prevent irreversible nerve damage.

De Quervain’s disease – caused by tendinitis of the thumb. Typically, it occurs in people performing repeated movements of thumb and thumb straightening (eg hairdressers, butchers, car mechanics, housewives, and young mothers when carrying an infant). The pain is located near the base of the thumb and side of the wrist, it intensifies when moving and grasping objects.

Ganglion – is the result of fluid leakage from damaged tendon sheaths or joints, which is visible under the skin in the form of a nodule (especially after a period of active movement); it can be tender or painless and is mainly a cosmetic problem.

Dupuytren’s contracture – in this disease there is thickening of the membrane located just under the skin of the hand (the so-called aponeurosis), which leads to gradual contraction of the fingers and the inability to fully open the hand; most often occurs in men over 50 (especially workers exposed to vibrations) and in people with diabetes. The risk of getting sick increases the alcohol abuse and smoking.

What should you pay attention to?

Because hand and wrist pain can have many causes, it is important to specify:

  • what caused the discomfort – often the reason is obvious, eg injury, overload related to sports or professional activity; sometimes the symptoms appear insidiously and for no particular reason (which may lead to the suspicion of inflammatory disease, especially in younger people)
  • which places exactly apply – different diseases have their specific locations, e.g. rheumatoid arthritis usually involves both wrists and symmetrical joints of the hands, but does not occupy the distal interphalangeal joints
  • are there other symptoms that may indicate inflammatory disease of the joints, in particular:
  • stiffness of joints lasting over an hour in the morning,
  • swelling, redness or increased warming of the joints,
  • general symptoms, such as low-grade fever / fever, unreasonable weight loss, severe weakness, disorder.

How to proceed?

  • If you experience a hand or wrist pain:
  • try not to overload aching joints – refrain from work intensifying ailments, do not carry heavy objects
  • you can apply hot or cold compresses to sore spots (even several times a day, no more than 20 minutes at a time)
  • if necessary, take paracetamol or a non-steroidal anti-inflammatory drug.

When to report to the doctor?

Report to a doctor if:

  • the pain does not subside within a few days or gets worse
  • you experience weakness or sensation (eg tingling or burning sensation)
  • other worrying symptoms will occur – swollen joints, nagging joint stiffness after waking up, low-grade fever, feeling of being broken.

What tests should be performed to determine the causes of hand and wrist pain?

To differentiate the causes of hand and wrist pain:

  • radiological image (X-ray) – it depicts bony structures, thanks to which post-traumatic changes can be visualized; X-ray is also helpful in diagnosing degenerative disease, RA and other joint diseases
  • ultrasonography – is a very useful examination for imaging of “soft” joint structures; it is used to recognize various pathologies within the hand (eg de Quervain’s syndrome, “latching finger”) and wrist (especially carpal tunnel syndrome – see above)
  • sometimes other imaging tests, such as magnetic resonance
  • nerve conduction examination in case of suspicion of carpal tunnel syndrome
  • laboratory tests – performed in some cases, if the doctor suspects RA or other joint disease (reference ato the study).

How is the pain of the hand and wrist treated?

Treatment depends on the cause of the complaint. Various physiotherapy methods, pharmacological treatment, topical steroid injections and sometimes also surgical procedures are used (see also individual disease entities).

Written by

Gregory Taylor