HAND and WRIST PAIN
Common Causes of Hand and Wrist Pain
Your hand probably has more structures in it than you realize. There are 27 bones, about 30 joints, and a complicated array of nerves, muscles and ligaments involved with movement. For those having hand or wrist pain, I’d like to share some of the more common reasons your hand might be hurting. The following are common causes of Hand and Wrist Pain.Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a nerve entrapment syndrome that occurs at the wrist. The bones of the wrist make a C-shape forming an arch that allows tendons, nerves and vessels to pass from the forearm to the hand. This arch-like passage is the carpal tunnel. If the shape of this tunnel changes or collapses, well then, you can imagine that the things that pass through the tunnel get compressed. This leads to a particular pattern of pain and numbness in the palm, thumb, index, middle, and half of the ring finger.You may notice weakness in the hand, uncoordinated movements, or dropping objects. Fixing this problem usually involves repositioning the bones with manipulation to form the arch again, then doing stretches and exercises to train the wrist to keep the correct shape of the arch. If you want to avoid surgery, try conservative approaches with physical medicine first.
Ulnar Tunnel Syndrome
Ulnar Tunnel Syndrome is another nerve entrapment syndrome, though less common than carpal tunnel syndrome, the idea is the same. There is a tunnel on the side of the hand called the “tunnel of Guyon” and the ulnar nerve passes through it. If the shape of the hand changes, or if there is trauma or inflammation, then this can affect this space and compress the nerve. Ulnar Tunnel Syndrome causes pain and numbness in the pinky and ring finger. We fix this the same way as carpal tunnel syndrome… we reposition the bones with manipulation and retrain the muscles in the hand to hold the position.Tenosynovitis
De Quervain’s Tenosynovitis is a mouthful to say, but it’s simple really to understand. There is a set of tendons that cross the wrist in order to move the thumb around. These tendons are covered by a sheath that helps them move smoothly. The tendons and the sheath can become inflamed and irritated. This can lead to scar tissue formation. As a result, this can cause problems with the tendon sliding inside of the sheath. Patients usually experience pain on the side of the wrist at the base of the thumb and across the wrist; sometimes into part of the forearm. My treatment for this usually involves ultrasound, soft tissue techniques, manipulation, exercise, and home instructions for icing and splinting.Ganglion Cysts
Ganglion Cysts are also known as bible bumps. They are soft, non-cancerous, but sometimes painful bumps that occur in the hand and wrist as a result of inflammation of the joint or tendon. This inflammation stimulates the over-production of fluid. This can lead to little outpouchings that stick up underneath the skin.Treating the underlying cause of the inflammation is important. This means assessing the hand and improving the mechanics to diminish the cause of the inflammation. Sometimes these go away on their own. Sometimes they go away and come back. Some people have them surgically removed only for them to grow again. So even if you have had surgery or plan on getting surgery, the mechanical dysfunction can persist creating another cyst. Therefore, you should address the underlying dysfunction to truly correct the problem.
Strains and Sprains Causing Hand and Wrist Pain (Including Stubbed Finger)
Sprains are ligament damage while strains are muscle damage. This is common in falls or sports injuries. A fairly common injury is the classic “stubbed finger”. This typically results in damage to the capsules in the finger joints. Depending on how old the damage is, the treatment varies. The acronym PRICE is great for remembering Protection, Rest, Ice, Compression, and Elevation for acute injuries (recent). But, It is often not enough just to let the damage heal on its own. I can’t tell you how many conditions I end up treating that are old injuries left untreated that turn into osteoarthritis after several years. If the joints are not aligned and a proper recovery is not made, those joints end up having dysfunction that cause excess wear and tear over the years. Just like a misaligned tire, the damage is worse the more you use it. Get these taken care of sooner rather than later.Arthritis Causing Hand and Wrist Pain
Arthritis is often the result of an old injury, as mentioned above, or a repetitive-type microtrauma. Osteoarthritis is the leading kind of arthritis we find affecting the joints of the hand. The base of the thumbs is usually the most commonly affected area followed by the wrist joints. The second most common type of arthritis is rheumatoid arthritis. This typically affects both hands and affects the smaller joints of the fingers first. Other types of arthritis like gout affect the hands to differing degrees. Treatment for these different arthritides (plural for arthritis) varies depending on the type, degree, and how long it’s been around.