Hands

What are some common causes of hand pain?

Arthritis is the most common cause of hand pain. Symptoms include stiffness, swelling, and loss of motion and function. Arthritis can affect any joint in the body, but it is especially bothersome when it affects the hands.

There are more than 100 different types of arthritis with the most common being osteoarthritis and rheumatoid arthritis.

Osteoarthritis. Osteoarthritis occurs when the cartilage between the bones begins to break down. Cartilage acts as a smooth padding, cushioning the bones and allowing the joint to move freely. When it deteriorates, the bones may rub together. Loss of cartilage and accompanying inflammation causes pain and stiffness. Osteoarthritis of the hand occurs more often in women than in men and tends to run in families.

The primary goal of treatment is to manage pain and improve function, enabling individuals to live without impairment and discomfort. Treatment options include heat and cold therapy, splints, pain relievers, anti-inflammatory medications, steroid injections, and physical therapy.

Surgery is typically a last resort. The two most common operations for hand arthritis are joint replacement (arthroplasty) and fusion (arthrodesis).

Rheumatoid arthritis. A chronic inflammatory condition, rheumatoid arthritis most commonly strikes the small joints of the wrist and hands. However, joints in the feet, neck, shoulders, elbows, hips, knees, and ankles also are vulnerable.

Affected joints may swell, feel warm and tender, and are especially stiff and painful when you wake up or after rest. Over time, joints may develop deformities. This condition also affects more women than men.

The most important goals in treating rheumatoid arthritis are maintaining your ability to move and function, reducing pain, and preventing future joint damage. Treatment combines medications, adequate rest, exercise, and lifestyle modifications with the help of an occupational or physical therapist.

Corticosteroid medications help reduce inflammation, and nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and swelling. Other medicines can help slow the progress of the disease. In some cases, surgery is needed to remove inflamed tissue or to reconstruct or replace the affected joint.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel, a narrow space in the wrist through which nerves and tendons pass. When this compression happens symptoms can appear in the hand, such as numbness, burning, tingling, pain, and weakness.

Symptoms may appear first at night and are most noticeable in the thumb, index, and middle fingers. There also can be pain in the wrist that radiates into the hand or the forearm.

People with carpal tunnel syndrome have difficulty gripping and holding objects like tools, pens, and eating utensils, and making a solid fist. The condition can occur in one or both hands and affects women more than men.

Causes of carpal tunnel syndrome include:

• Wrist arthritis
• Injury to the wrist
• Diabetes
• Repetitive movements like typing and using tools
• Thyroid disease, particularly an underactive thyroid
• Pregnancy

Doctors usually diagnose carpal tunnel syndrome based on your history of symptoms and a physical exam. Your doctor may order blood tests to check for diabetes or thyroid disease.

Most people with carpal tunnel syndrome recover entirely with treatment (or, in the case of pregnancy, delivery). Typically, therapy begins with a wrist splint worn mainly at night. You may also receive anti-inflammatory medication to decrease pain and numbness. Injections of cortisone may help reduce swelling, but they tend to provide only temporary relief.

Carpal tunnel syndrome caused by overuse may recover with treatment, rest, and modified activity. Arthritis or an injury may require prolonged treatment and therapy.

People can reduce their risk for carpal tunnel syndrome caused by repetitive typing by working in a wrist-neutral position, with the wrist joint straight, not bent up or down. Several types of office aids, including cushioned wrist rests and keyboard trays that adjust to a position below the work surface, can help you achieve the wrist-neutral position.

For people who don’t improve with initial treatments, surgery to relieve pressure on the median nerve may help. The surgery involves cutting a ligament in the wrist to create more room for the nerve in the carpal tunnel.

What is trigger finger?

Trigger finger, also known as stenosing tenosynovitis, is a painful condition in which a finger catches or becomes locked when you try to straighten or bend it. The name comes from the trigger-like snap when the finger suddenly releases. This condition usually affects the thumb or ring finger.

Trigger finger begins in the tendons involved in bending the fingers and the connective tissue pulleys that hold those tendons close to the finger bones. The tendon typically glides smoothly through the sheath that surrounds it. However, if the tendon develops a knot or if the sheath covering the tendon swells and narrows, movement is hampered. The tendon can snag and get stuck, causing pain, popping, or a catching feeling in the finger or thumb.

The first symptoms of trigger finger tend to be pain and a slight thickening at the base of the affected finger or thumb. The characteristic snapping sensation can start suddenly or develop gradually. Discomfort may be felt toward the tip of the finger, or thumb, or in the palm. You may find that the finger or thumb is locked toward the palm when you wake up and gradually releases over the day.

It’s not clear what causes trigger finger. However, it’s more common in people over age 40, those with rheumatoid arthritis, gout, or diabetes, and people who use their fingers or thumbs in repetitive movements, such as musicians and industrial workers.

The first step in treatment is to immobilize the affected finger or thumb, either by taping it to a neighboring finger or by using a splint. Splinting at night can be especially helpful in preventing the thumb or finger from becoming locked.

Applying an ice pack several times a day can help if the digit is painful. An over-the-counter nonsteroidal anti-inflammatory drug like ibuprofen (Motrin) or naproxen (Aleve) can help ease pain and inflammation.

Gentle finger stretching and strengthening exercises also may help ease stiffness and improve finger and thumb range of motion.

If severe locking or other symptoms occur after four to six weeks of immobilization, your healthcare provider may recommend a steroid injection into the base of the affected finger or thumb.

When locking and pain persists, surgery may be the best option. Surgery for trigger finger opens the tunnel through which the tendon passes. This lets the tendon glide properly through the sheath.

Why are my hands cold and numb?

People who experience extremely cold or numb hands, fingers, or toes may have a blood vessel disorder called Raynaud’s disease. The condition is also knowns as Raynaud's syndrome and Raynaud’s phenomenon.

In healthy people, a cold environment causes tiny blood vessels in the skin to constrict. This is the body’s effort to conserve heat. However, that natural response to cold is exaggerated in people with Raynaud's disease. The tiny blood vessels go into spasms, narrowing and reducing the blood flow to the affected areas. The skin blanches or turns white, then blue, then red, followed by a tingling or numbing sensation. This response is seen most often in the fingers and toes but can also occur in the ears, cheeks, and nose.

In some cases, the constriction also may occur in response to emotional stress or a rapid change in temperature from warm to cool. Or it may happen for no apparent reason.

Raynaud's disease is considered a long-lasting condition, and the cause is usually unknown. Fortunately, the effect is temporary and rarely dangerous. An episode may be stopped by warming the affected areas, for example, by going indoors or soaking fingers or toes in a bowl of warm (not hot) water. The blood vessels relax and expand once the affected region is warmed, allowing more blood flow. There can be throbbing or soreness as the blood surges into the tiny blood vessels.

For more severe cases, medication used for high blood pressure may be prescribed to reduce the severity and number of episodes.

There is no way to prevent Raynaud’s disease. However, once the disorder is present, the number of episodes can be reduced or even eliminated by avoiding situations that can trigger events. For example:

• Avoid unnecessary exposure to the cold.
• Keep your head and hands covered to conserve as much warmth as possible.
• Use hand warmers and/or foot warmers when in cold environments.
• Utilize pot holders, mittens, or a towel to remove items from the refrigerator or freezer.
• Use a cup holder when drinking cold beverages.