Hand Pain - Causes, Diagnosis and Treatment

Introduction:

The upper limb of a human body comprises the shoulder, arm, elbow, forearm, wrist, and hand (palm, backhand, and fingers). They are supported by various muscles, bones, and joints for movements. The primary function of a hand is to manipulate objects according to requirements. Therefore, pain in the hand may bring impairment in work and decrease participation in social activities.

What Is Meant by Hand Pain?

Hand pain is an unpleasant feeling that hinders your hand movement and activity. Hand pain may be mild or severe. It is usually a response to any underlying problem. Therefore, identifying the cause and treating the condition can alleviate hand pain.

What Are the Causes of Hand Pain?

The two primary reasons for hand pain are trauma and any underlying disease. The pain can occur in the wrist, thumb, fingers, palm, or back of the hand. Swelling, wound, redness, nerve injury, mineral or vitamin deficiency, numbness, tingling sensation, muscle spasms, finger stiffness, or erection are contributing factors to hand pain. Some of the following causes of hand pain are briefed below -

1. Carpal Tunnel Syndrome (CTS):

The numbness, tingling sensation, or pain caused by a compressed nerve is called carpal tunnel syndrome. The condition occurs when pressure is applied to one of the major nerves of the arm, the median nerve (which carries sensations and activity signals of the arm).

A carpal tunnel is a narrow passage in the wrist surrounded by carpal bones (tiny bones that make up the wrist). The median nerve travels through the carpal tunnel and innervates the thumb, index, middle, and ring finger. Therefore, narrowing of the passage or exertion of abnormal force on the nerve by the swelling of surrounding tissues causes pain.

The risk factors for this condition may be hereditary, hand-wrist position, repetitive hand use, and other health conditions. Giving rest to the hand and wrist, pain killers, anti-inflammatory drugs, and physical therapy may provide some relief.

2. Arthritis:

Arthritis is swelling and tenderness of joints that causes pain and stiffness. Arthritis is usually age-related (osteoarthritis - wear and tear of tissues in bones and joints) or autoimmune (rheumatoid arthritis - immune system attacking the joints). The hand and wrist have multiple small bones and joints which work together to bring movements. Therefore arthritis can occur in many hand areas, causing pain and swelling. Medicines, self-care, and physiotherapy are proposed to treat arthritis.

3. Vitamin D Deficiency:

Vitamin D is a crucial component of bone health. Research suggests that low levels of vitamin D cause muscle and joint pain.

4. De Quervain Tenosynovitis:

De Quervain's tenosynovitis or tendonitis is the pain caused in the thumb's tendons (the tissue that connects muscle to bone). The pain may travel through the thumb and extend up to the forearm. The condition resists the thumb and wrist from holding, grasping, or fisting.

5. Ganglionic Cyst:

A small, round, non-cancerous swelling rising in the tendons of the wrist and hand are called ganglionic cysts. The cyst might cause mild pain and weakness in the hand. Such cyst may drain itself or be removed professionally.

6. Raynaud’s Disease:

Raynaud's phenomenon is a condition where smaller arteries constrict excessively, resulting in cold-causing numbness and pain in fingers and toes. The hand may change color in such a situation, and the pain may last from a few minutes to extended hours.

7. Scleroderma:

Stiffness of the skin and other organs due to abnormalities in the immune system, connective tissue, and small blood vessels is called scleroderma. Scleroderma patients have thick and swollen fingers that cause stiffness in the hands, especially in the mornings.

8. Trigger Finger:

Irritation of the tendon causing the fingers or thumb to bend and lock in the same position is called trigger finger or tenosynovitis. Removing the trigger or pulling the finger may straighten the affected digit.

9. Fracture:

Any fracture of a bone in hand due to trauma causes extreme pain until the fracture is stabilized and healed. Then, the joints will become stiff and lack free movement.

10. Sprain:

A sprain is a stretching or tearing of the ligaments (band of elastic tissue around the joints). For example, a wrist or hand sprain may occur when there is a direct blow, hit hard with an object, sudden fall, or twist on the hand.

How to Diagnose Hand Pain?

A complete patient history and laboratory investigations reveal the cause of hand pain. The following are the tests recommended for diagnosing hand pain.

Blood Test:

The following tests rule out the presence of inflammation in the body:

• ESR (erythrocyte sedimentation rate).

• CBC (complete blood count).

• CRP (C-reactive protein).

• RF (rheumatoid factor).

• ACPA (anti-citrullinated peptide antibody).

Apart from the tests mentioned above, the levels of vitamin D and uric acid in the blood also contribute to finding the source of hand pain.

X-Ray:

An X-ray is used to visualize the injured hand or wrist for fracture.

MRI (Magnetic Resonance Imaging):

MRI is performed to rule out neuritis (inflammation of the nerve) or sprain.

CT Scan (Computed Tomography):

CT scan can provide detailed information on hard and soft tissue structures.

How to Treat Hand Pain?

The treatment of hand pain relies on identifying the cause and treating the condition. Some conservative management includes:

• Medication: NSAIDs (non-steroidal anti-inflammatory drugs) reduce joint swelling, stiffness, and pain.

• Rest: Minor injuries, overuse, or stress-related pain resolves with adequate rest.

• Ice Packs: Applying ice packs to the injured area reduces inflammation.

• Heat Therapy: Applying heat loosens stiff joints and soothes the achy muscles.

• Physiotherapy: Physical therapy is recommended to reduce stiffness and improve hand movements.

• Therapeutic Ultrasound: The application of ultrasound to an area increases the blood flow and reduces the tingling and numbness of the hand.

• Surgery: In major fractures, ligament injury, and unresolved carpal tunnel syndromes, surgery is preferred.

Conclusion:

The hand remains a crucial part of the body for everyday activities, and therefore hand pain can be debilitating. Damage to any part of the hand, such as tendons, ligaments, bones, or joints, severely hampers the routine lifestyle. It is advisable to seek a physician’s help if the pain limits the daily work plan. Hand pain can be cured with simple solutions when detected and treated early.