Hand pain is one of the most common afflictions seen in a rheumatologist’s office. The diagnosis is often difficult to make because there are so many conditions that can cause pain in the hand.
Pain is a symptom – much like fever is – and it is not a diagnosis. Establishing the underlying cause of hand pain is important because some conditions that account for hand pain can lead to loss of normal function.
Here are a few of the common causes:
Arthritis at the base of the thumb
This occurs when the joint between the wrist and the base of the thumb develops osteoarthritis. The condition is more common after the age of 40. A combination of factors, including genetics, aging, injury, and repetitive motion may lead to thumb arthritis. Symptoms include pain, swelling, and a sometimes a grinding sensation at the base of the thumb. Grip requiring apposition (thumb opposite the rest of the fingers) causes pain.
This problem is called stenosing tenosynovitis. It is an often painful condition where one or more fingers catches or locks as the digit or digits are bent or straightened. In severe cases, the finger may become locked in a bent or straightened position so that it can’t be moved any farther. The cause of this problem is a thickening of the tendon sheath, the lining which surrounds the finger tendon. Trigger finger is more common in people whose vocation or hobby requires repetitive gripping motion. It is also more common in those with certain diseases such as rheumatoid arthritis, diabetes or hypothyroidism.
These cysts are fluid-filled bumps that occur on the wrist or finger joints. They are not malignant. Ganglion cysts typically develop along the tendons or joints of the wrist and hands. The cysts are filled with a thick gel-like fluid. They are most often painless, but not always. Ganglion cysts can cause pain, weakness or numbness in the hand if they exert pressure on nerves. The cause of ganglion cysts isn’t clear. They occur more commonly in patients with osteoarthritis or with injured joints or tendons. Ganglion cysts are demonstrated well with the use of ultrasound. If necessary, because of painful symptoms, these cysts can be aspirated with a needle using ultrasound guidance.
Tendonitis in the wrist occurs most commonly at the volar side (palm-side).The most common symptoms of wrist tendonitis are pain with motion. Sometimes, swelling is present as well. One very common type of hand tendonitis is de Quervain’s tenosynovitis. This is tendonitis involving the tenodon that allows the thumb to extend (move away from the hand). Symptoms include severe pain and swelling about a centimeter back from the base of the thumb.
Movements such as pinching and grasping aggravate the pain. Chronic de Quervain’s tendonitis can cause pain to spread into the thumb and forearm. Wrist tendonitis is caused by irritation and swelling of the sheath that surrounds the major tendons connecting the wrist and hand.
Another type of tendonitis carries the label of “new mother’s” disease. It is the result of overuse of the wrist and thumb in new parents who lift their babies with their thumbs extended and wrists bent backwards.
Carpal tunnel syndrome
This condition is due to compression of the median nerve as it enters the hand from the wrist. It starts with a vague aching in the wrist that extends to the hand. It can also radiate upward into the forearm. Symptoms may consist of numbness and tingling in the fingers, particularly at night. If it progresses, carpal tunnel syndrome leads to weakness in the hand. Any activities that involve repetitive flexing and extending of the hand or wrist can cause the problem. Other diseases such as hypothyroidism, gout, pseudogout, rheumatoid arthritis, and psoriatic arthritis can also cause carpal tunnel syndrome.
Many forms of arthritis can cause hand pain. Often swelling is present as well. Rheumatoid arthritis (RA) is a severe inflammatory form of arthritis. Swelling, redness, heat, and pain are present. It generally affects the wrist and the metacarpophangeal joints (row of knuckles nearest the wrist) and the proximal interphalangeal joints (row of joints nearest the knuckles). RA is symmetric, meaning the right hand and left hand tend to have the same joints affected.
Osteoarthritis affects the proximal interphalangeal row and the distal interphalangeal row (last row of finger joints- the ones farthest away from the wrist). OA is not necessarily symmetric, but it can be. The base of the thumb is often involved.
Psoriatic arthritis – the arthritis associated with psoriasis- affects the fingers in a non-symmetric fashion and causes “sausage” fingers.
Gout and pseudogout can also cause an inflammatory form of arthritis that affects the hands and wrists. In particular, gout can cause painful areas of swelling called tophi. These tophi are deposits of uric acid crystals.
Systemic lupus erythematosis, scleroderma, and dermatomyositis are less common conditions that cause a symmetric inflammatory form of arthritis.
There are rarer conditions that can cause hand pain. An example is reflex sympathetic dystrophy. Reflex sympathetic dystrophy is a little-understood dysfunction of the nerves and circulation to an arm or leg. The underlying cause is usually trauma to that limb. The affected hand or foot will develop severe pain, and become cold, and also have a peculiar loss of hair and sweating pattern.
Treatment for any of the above conditions starts with a visit to a rheumatologist.
A careful history physical exam, laboratory tests, and imaging procedures will help establish the diagnosis.
The diagnosis will then determine the course of treatment.
About the Author: Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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