Hand Pain and Problems

Anatomy of the hand

The hand is made up of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

• Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal). Only the thumb has 2 phalanges.

• Metacarpal bones. The 5 bones that make up the middle part of the hand.

• Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm, the ulnar bone and the radius bone.

Many muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are some common hand problems?

There are many common hand problems that can interfere with activities of daily living (ADLs), including:

Arthritis

Arthritis is loss of joint cartilage, often with inflammation, pain and stiffness. It can occur in many areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands. It may be caused by normal use of the hand. Or it may develop after an injury. Osteoarthritis often develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Symptoms of osteoarthritis include: 

• Stiffness

• Swelling and pain

• Bony nodules at the middle or end joints of the finger

• Pain and possibly swelling at the base of the thumb

• Loss of strength in the fingers and the grip of the hand

Treatment for osteoarthritis includes:

Over-the-counter pain and fever medicines (NSAIDs or nonsteroidal anti-inflammatory drugs)

• Resting the affected hand

• Wearing splints at night

• Using heat to soothe the pain

• Using ice to reduce swelling

• Possible cortisone injections

• Possible surgery when no other treatments work 

Carpal tunnel syndrome

With this condition, the median nerve is squeezed or compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.
Each person’s symptoms may be different. Symptoms may include:

• Trouble gripping objects with the hand

• Pain or numbness in the hand

• "Pins and needles" feeling in the fingers

• Swollen feeling in the fingers

• Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. Always see your healthcare provider for a diagnosis.

Treatment may include:

• Splinting the hand. This is done to help prevent wrist movement and decrease the compression of the nerves inside the tunnel.

• Medicines to reduce swelling. Anti-inflammatory medicines can be taken by mouth (oral) or injected.

• Surgery. This is done to relieve compression on the nerves in the carpal tunnel.

• Ergonomic changes. Making changes to your work environment, such as changing the position of a computer keyboard.

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts. . They are the most common noncancer, soft-tissue tumor of the hand and wrist.

The most common symptoms for ganglion cysts include:

• Wrist pain that gets worse with repeated use or irritation

• A slow growing, localized swelling, with mild aching and weakness in the wrist

• An apparent cyst that is smooth, firm, rounded, or tender

The symptoms of ganglion cysts may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.

At first, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and hand function is treatment usually necessary. Treatment may include:

• Rest

• Splinting

• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen

• Aspiration

• Cortisone injections

• Surgery

Tendon problems

Tendons are the tough cords of tissue that connect muscles to bones. Two major problems linked to tendons are tendonitis and tenosynovitis. Tendonitis is inflammation of a tendon. It can affect any tendon. But it is most often seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is often the site which becomes inflamed. But both the sheath and the tendon can become inflamed at the same time. The cause of tenosynovitis is often unknown. But usually strain, overuse, injury, or excessive exercise may be a factor. Tendonitis may also be linked to disease such as diabetes or rheumatoid arthritis.

Common tendon disorders include:

• Tennis elbow (lateral epicondylitis). There is pain in the outside of the elbow and forearm. The pain is along the thumb side when the arm is next to the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.

• Golfer’s or baseball elbow (medial epicondylitis). Pain goes from the elbow to the wrist on the inside of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.

• Rotator cuff tendonitis. A shoulder disorder with inflammation of the shoulder capsule and related tendons.

• DeQuervain's tenosynovitis. The most common type of tenosynovitis disorder. There is tendon sheath swelling in the tendons of the thumb.

• Trigger finger or trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened. This prevents the smooth extension or flexion of the finger or thumb. The finger or thumb may lock or "trigger" suddenly.

Treatment for most tendon problems may include:

• Reducing your activity level

• Ice

• Splinting or immobilization

• Steroid injections

• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen

• Surgery