Pain in the hand can be caused by various reasons. The whole arm or some part of it may hurt. The pain can be of a different nature: dull, burning or numbing, shooting or piercing, etc., it can occur suddenly or develop gradually.
Typically, people experiencing pain in their hand complain of:
- Pain in the wrist, palms and hands;
- Elbow pain;
- Shoulder pain;
- Pain in the shoulder blade.
Pain in the hand is often a consequence of various injuries, overexertion, and can occur as a result of excessive physical activity or prolonged work in an uncomfortable position. For example, a common occupational disease in our time among those who work at a computer for a long time has acquired the name “tunnel syndrome.” Pain in the arm can be one of the symptoms of diseases of the cardiovascular system, musculoskeletal system, nerve trunks and endings.
If there are no visible external injuries, it is necessary to check the condition of the cervical spine, since the cause of pain may be a protrusion or herniation of the intervertebral disc. Pain in the hand is not always felt directly at the site of injury; if the wrist is affected, it often spreads to the forearm area. Sometimes pain in the upper arm occurs as a result of heavy lifting. It can also be caused by an inflammatory process in the tendons of the shoulder muscles.
If pain has already appeared, discomfort does not go away for more than 3 days or periodically recurs for no apparent reason, you should go to an orthopedist.
Important information: Dear patients! If you have been diagnosed with rheumatoid arthritis, you need to see a rheumatologist. With a rheumatological profile, in addition to the joints, internal organs (heart, kidneys, etc.) may also suffer, so rheumatoid arthritis should be treated by a rheumatologist. The treatment of allergic, gouty and infectious arthritis is carried out by specialists of the relevant profile (allergists, rheumatologists and cardio-rheumatologists).
Orthopedic doctors successfully treat all other types of arthritis in children and adults (caused by sports and household injuries, excess body weight, age-related changes in joints).
Causes of hand pain
Traumatic injuries
A hand bruise occurs as a result of a blow or fall and is manifested by moderate, gradually subsiding pain, swelling, and slight limitation of limb function.
Possible bruises and abrasions. On palpation, local pain is noted, the symptom of axial load is negative. All manifestations disappear after 1-2 weeks. Fractures of the II-V metacarpal bones are formed when struck with a fist or falling on a fist. Injuries of the V predominate, sometimes in combination with a fracture of the IV metacarpal bone. Injuries of the II metacarpal bone are less common, and very rare - of the III metacarpal bone. Fractures are manifested by sharp pain, which almost does not subside over time. The hand is swollen, especially in the projection of the damaged bone, and is often deformed. On palpation, a crunch and pathological mobility are determined. The function is sharply reduced.
When the first metacarpal bone is fractured, the diaphysis or base of the bone suffers. In the first case, maximum pain is found in the central part of the thenar, in the second (with Bennett's fracture) - just above the wrist joint. Bennett's fracture is accompanied by displacement of the distal fragment of the metacarpal bone and external deformation of the base of the thenar. An active grip involving the first finger is impossible; when you try to clench your hand into a fist or oppose the first finger, the pain increases sharply.
Wrist fractures are less common. Mostly the base of the hand swells. Depending on the type of fracture, the pain is localized:
- scaphoid bone - on the side of the first finger, strengthens with pressure on this finger;
- lunate bone - in the middle part of the hand, intensifies with axial load on fingers III and IV;
- pisiform bone - on the side of the fifth finger, grows when trying to bend the little finger.
Dislocations of the wrist bones are often combined with fractures and are manifested by extremely intense pain, significant swelling, and severe deformation of the hand. The functions of the hand are almost completely lost due to severe pain.
Soft tissue diseases
For de Quervain's disease (stenosing ligamentitis), painful sensations in the area of the wrist joint are more typical, but in half of the patients, aching or pressing pain also occurs in the thenar area and radiates to the thumb. At first, the pain syndrome is detected only with excessive abduction and extension of the first finger, then it begins to bother you with any movements, and sometimes persists at rest.
Aseptic tenosynovitis of the tendons of the fingers begins acutely against the background of overload, manifests itself as a constant nagging pain that intensifies with finger movements, is accompanied by limitation of movements, mild swelling, and hyperemia. As the process becomes chronic, the intensity of pain decreases; it is observed only during exercise; patients complain of a feeling of cramped hand.
Hygromas most often form on the back of the wrist joint, but can also be located on the palmar side of the hand. Initially, they are usually painless, but with active movements of the hand or pressure from a hard object, minor or moderate pain may occur. Unlike formations of other localizations, palmar hygromas are distinguished by significant density and may resemble bone outgrowths.
Hand pain
Dermatological problems
A water callus forms on the palmar surface in the area of the heads of the metacarpal bones; it is a consequence of unusual or too long work with the instrument. First, mild local pain, slight swelling, and redness occur. Then a bubble forms on the palm, the pain becomes intense, tugging, stabbing, cutting, intensifies with movements and touch. After opening the bladder, a painful wound appears.
When the wound becomes infected or microbes penetrate into the bladder through cracks in the skin, a callus abscess develops with rapidly increasing pain that takes on a twitching, pulsating character. The pain bothers you at night, intensifies with pressure or lowering the hand, and is accompanied by a slight increase in temperature and swelling of the back of the hand. When pus breaks through into the surrounding tissues, the condition worsens even more, the pain becomes diffuse, weakness is noted, and the temperature reaches febrile levels.
Infectious processes
Boils and carbuncles in the hand area are rarely formed, more often detected in men, located on the dorsal surface of the segment. They are accompanied by increasing local pain, which within a few days becomes very intense, bursting, tugging, and deprives you of sleep at night. An external examination reveals a limited purulent focus up to several centimeters in diameter, bluish-purple in color, with one or more necrotic cores.
Cellulitis of the hand is usually a complication of felon, infected wounds and abrasions. Accompanied by strong tugging diffuse pain, depriving sleep, preventing any movement of the hand. Weakness, hyperthermia, and symptoms of intoxication are noted. The swelling is more pronounced on the back side, a cushion-like compaction is visible on the palm, and the fingers fan out to the sides.
Hematogenous osteomyelitis rarely affects the bones of the hand; post-traumatic and postoperative forms of the disease are more typical for this localization. The pathology is manifested by the appearance or intensification of pain, progressive edema, hyperemia, deterioration of general condition, weakness, hyperthermia. The pain is sharp, jerking, tearing, clearly localized, so strong that the patient avoids any movement of the limb.
Arthrosis
Rhizarthrosis of the 1st finger (arthrosis of the 1st metacarpophalangeal joint) is manifested by pain at the base of the thumb. At first, the pain is short-term, appearing at the beginning of movements and after exercise. Subsequently, the duration and intensity of the pain syndrome increase. The joint is deformed, the opposition of 1 finger is disrupted, which entails a limitation of the function of the limb.
After single gross injuries or repeated microtraumas, arthrosis of the wrist joints develops with carpal reconstruction of the bone tissue. At the initial stage, patients complain of heaviness in the hands, awkwardness of the hands, short-term tingling pains without clear localization. Then the symptoms become permanent, and after the cysts break through, they are replaced by acute pain, swelling and dysfunction.
Other joint diseases
In rheumatoid arthritis, the interphalangeal joints are usually affected first, followed by inflammation in the metacarpophalangeal joints. Along with pain in the fingers, there is pain in the distal parts of the hand and wrist joint. The pain is periodic at first, then long-lasting, combined with morning stiffness. Palpation of the hands is painful; “rice bodies” are often felt. In later stages, gross deformations are revealed.
Arthritis with polymyositis is detected in 15% of patients and is characterized by pain in the joints of the hand and fingers. The pain is moderate, dull, aching, periodic, combined with swelling, redness, limitation of movements, and the deposition of calcifications. There are usually no deformations. The main manifestation of the disease is muscle pain and muscle weakness.
Hydroxyapatite arthropathy is characterized by constant dull pain that worsens at night, morning stiffness, and slight swelling of the joints. Manifestations of tenosynovitis or a course similar to carpal tunnel syndrome with shooting pain in the palm of the hand, radiating to the fingers and forearm, are possible. Deformations are not formed.
Tumors
The bones of the hands are more often affected by benign neoplasias – osteoid osteomas and chondromas. Osteoid osteomas are accompanied by sharp local pain and are less likely to be asymptomatic. With chondromas, the pain is vague, indistinct, not intense, and slowly progresses as the tumor grows. Malignant tumors of the hands are uncommon.
Neurological causes
When the nerves are damaged, the pain in the hand is burning, shooting. They often spread to other parts of the limb and are combined with muscle weakness, trophic disorders, and sensitivity disorders. Detected under the following conditions:
- Median nerve neuropathy.
Painful sensations are often causal in nature and localized in the radial half of the palm, the thenar region. - Radial nerve neuropathy.
Patients experience burning pain along the dorsum of the hand, which can radiate to the fingers, shoulder and forearm. - Ulnar nerve neuropathy.
The pain syndrome is detected along the ulnar edge of the palm, spreading from the elbow joint along the forearm to the fingers. - Carpal tunnel syndrome.
Shooting pain and tingling are noted along the palmar surface of the hand on its radial side. Irradiation to the forearm and fingers is possible.
Pain in the hands can also appear with some neurotrophic pathologies: shoulder-hand syndrome, anterior scalene syndrome, cervicocostal syndrome. Pain in the distal upper limb is characteristic of cervical osteochondrosis, intervertebral hernias, spondyloarthrosis, and other spinal diseases.
Other reasons
Occupational neuroses, some neurological and mental pathologies are accompanied by the appearance of writer's cramp - pulling, aching pain in the hand that occurs when writing, typing, combined with cramps, trembling, and weakness of the distal parts of the limb. In addition, pain in the projection of the hand is observed with the following pathologies:
- Myocardial infarction.
Chest pain often radiates into the arm, including the hand and fingers. - Post-infarction state.
Every fifth patient with a heart attack in the long-term period develops pain and paresthesia of the hand caused by neurotrophic disorders. - Vein diseases.
Thrombophlebitis, varicose veins, and postthrombophlebitis syndrome in some cases develop after intravenous injections into the veins of the dorsum of the hand.
Symptoms of pathology
The typical location of pain is the lateral surface of the forearm just below the wrist. There may also be swelling and, less commonly, slight redness of the skin. The problem intensifies after working with a brush and subsides after rest. In this case, a wrist orthosis or bandage can help, but first you need to make an appointment with a specialist.
To clarify the diagnosis, a special test has been developed, called the Finkelstein test. The thumb must be pressed with other fingers of the same hand. After this, carefully tilt the hand towards the little finger. Increasing or the appearance of sharp pain indicates that the patient has De Quervain's syndrome.
Diagnostics
The causes of pain are determined by orthopedic traumatologists. To make a diagnosis, the results of a survey, physical examination, instrumental and laboratory techniques are used. May be assigned:
- X-ray of the hand.
Performed in 2 or 3 projections, it makes it possible to diagnose fractures, dislocations, arthrosis, arthritis, osteomyelitis, and neoplasms. - CT scan of the hand.
More informative when studying solid structures. Recommended for complex fractures and fracture-dislocations, arthritis, arthrosis, osteoporosis. Allows you to accurately localize the area of damage, assess the nature and extent of the pathological process. - MRI of the hand.
Indicative when studying soft tissue formations. It is prescribed to study the condition of muscles, ligaments, tendons, blood vessels, and nerves. It is used for tendinitis, arthrosis, arthritis, purulent processes, and carpal tunnel syndrome. - Electrophysiological techniques.
They are used for neurological causes of pain in the hand to determine the level of nerve damage, assess nerve conduction, and the condition of muscle tissue. - Lab tests.
They are performed to identify signs of inflammation, specific markers, assess the activity of various organs in systemic pathologies, and study the structure of tissue during histological or cytological analysis.
To make an accurate diagnosis, an examination by a specialist is required.
Treatment
Help before diagnosis
Fractures and dislocations are fixed with a splint and cold is applied. For all injuries and diseases accompanied by swelling of the limb, an elevated position of the hand is recommended. For intense pain, an analgesic is given. In most cases, pain decreases with rest, so patients are advised to reduce physical activity (except for cases where the pain goes away with movement). In case of increasing acute pain, hyperthermia, or intoxication, an urgent consultation with a doctor is indicated.
Conservative therapy
For dislocations and fractures, local anesthesia, reduction, and fixation with a plaster cast are performed. Patients with injuries and diseases of the hand are prescribed:
- Protective mode.
The patient may be recommended immobilization with a plaster cast or scarf, the use of orthoses, and load limitation. - Drug therapy.
For arthritis, arthrosis, and some other pathologies, NSAIDs are used, for infectious processes - antibiotics, for neurological disorders - neurometabolites. If intense pain persists, blockades with glucocorticoids are performed. - Non-drug methods.
They provide massage, exercise therapy, physiotherapeutic procedures, including electrophoresis, UHF, and mud therapy. Laser therapy, magnetic therapy, and other techniques are successfully used.
How to treat De Quervain's disease?
If the disease arose relatively recently, a good effect is achieved fairly quickly. Even if pain persists for a long time, it is better to start with the safest methods. The following activities work best:
- Temporary fixation of the first finger and wrist with an orthosis or cast. Eliminating stress on the tendons allows them to recover faster. A good orthosis will fix the finger, but will not interfere with the active work of the entire hand.
- Short-term use of NSAIDs and local cooling. For severe pain, medication is prescribed and it is recommended to apply cold objects (for example, an ice bottle through a cloth) to the painful point.
- Light massage and special exercises. Outside the period of exacerbation, physical development of the finger helps to endure the rehabilitation period more comfortably. According to patient reviews, various massagers, needle rollers and kinesio taping often help.
- Blockades with steroids. Sometimes the pain is so severe that anti-inflammatory agents must be injected directly into the tendon sheath. This works well in the short term, but has many disadvantages in the future.
If the pain persists for years, and conservative treatment does not produce results, the patient is indicated for surgery. In this case, the surgeon cuts the canal of the tendons, and they move more freely. The advantage of surgery is a tangible quick effect, the disadvantage is the risk of infectious complications and unintentional tendon damage.