The wrist and hand are capable of power and precision. As a result, pain and swelling are often accompanied by weakness of grip in hand disorders. A careful history and a complete physical examination are important. The presence of symptoms elsewhere in the body is important to establish.
Two serious hand problems are:
• Reflex sympathetic dystrophy (RSD). This is caused by a disorder of the sympathetic nervous system. Typically, it is described as a burning pain. The precipitating factor may be trauma Color changes including purplish discoloration of the fingers may occur. The treatment involves a special procedure called stellate ganglion block. Usually performed by an anesthesiologist, this procedure is often very effective.
• Hypertrophic osteoarthropathy. The hand becomes swollen and painful. This picture occasionally occurs in patients with underlying cancers.
Other hand problems that point to other diseases:
• Psoriasis may also cause pitting or lifting up (onycholysis) of the fingernails.
• Abnormal blood vessel patterns near the fingernails may signify auto-immune diseases like lupus.
• Raynaud’s phenomenon… When fingers blanch (turn white) this may be a sign of an underlying autoimmune problem such as systemic lupus erythematosus or scleroderma.
• Bumps, called “nodules” can develop as a result of osteoarthritis, gout, and rheumatoid arthritis.
• Depuytren’s contracture is a problem where the skin in the palm may become thickened and shortened. A cord of tissue develops and causes fingers to bend into the palm. Treatment for this problem may be steroid injection, splinting, and physical therapy. Surgery is often needed. This condition occurs with other medical diseases.
Virtually all types of arthritis can affect the wrist and hand.
Arthritis when untreated or poorly treated will lead to deformity. Tendonitis is another common problem in the wrist and hand. In the wrist, tendonitis usually causes pain and localized swelling. Tendonitis can be confused with arthritis.
Tendonitis in the hand is most common in the palm. This causes locking or triggering of the fingers. Steroid injection and physical therapy are usually effective treatments. Treatment consists of anti-inflammatory medication, steroid injection, splinting, and occasionally physical therapy.
Tips to make your hand pain better…
• Wear splints if you’re going to be doing a lot of repetitive motions
• Use your whole arm instead of just your hand and wrist
• Enlarge the handles on your tools. You can get kitchen utensils and writing implements with enlarges handles. They’re worth it.
• Make sure to take rest breaks.
• Avoid repetitive movements when possible.
• Carry objects with the palms open and flat. This will take the pressure off your wrists and fingers.
A common cause of hand pain is carpal tunnel syndrome
… pinching of the median nerve in the wrist. Carpal tunnel syndrome is a symptom- much like fever… it is not a disease! It is the most common cause of tingling in the hands. Besides tingling, burning pain may also occur. Patients often have discomfort at night that is relieved by hanging the affected hand over the side of the bed or vigorously shaking the hands. The discomfort of carpal tunnel syndrome can also be brought on by holding up the newspaper while reading, or by driving. Causes of carpal tunnel syndrome include arthritis, endocrine problems, pregnancy, trauma, infection, tumors, and overuse. Treatment of carpal tunnel syndrome depends on the severity. Mild to moderate carpal tunnel syndrome is treated with splinting, sometimes steroid injection, and avoidance of overuse. For patients with carpal tunnel syndrome that doesn’t respond to conservative measures or where the carpal tunnel syndrome is severe, surgery is indicated.
Radial nerve damage leads to wrist drop. Radial nerve pressure in the wrist can occur as a result of repetitive motion, tight pressure (handcuffs, watchbands, bracelets), diabetes, and trauma. Ulnar nerve damage and compression in the wrist can cause a “claw hand.” Treatment consists of anti-inflammatory medication, rest, splinting, injection, and sometimes surgery.
Treatment of hand disorders is entirely dependent on making an accurate and specific diagnosis.