PAIN AND ORTHOPAEDICS · Health guide
Hand and Wrist Pain: Causes and Assessment
Tendon, joint and nerve-related symptoms in hand and wrist pain: assessment of numbness, grip strength and everyday use.
Updated: · General information
Who is affected?
Hand and wrist pain is among the most frequent complaints in the population; the complex structure of the hand makes possible everything from gripping a tennis racket to holding a pen or playing a musical instrument. It is more common in manual occupations such as food processing, construction and manufacturing, in homemakers, in people who use a computer for long periods, and in those with inflammatory diseases such as rheumatoid arthritis, gout or psoriasis.
Causes
The principal causes are nerve entrapments (carpal tunnel syndrome, ulnar neuropathy), degenerative changes (particularly osteoarthritis of the thumb joint), inflammatory arthropathies (rheumatoid arthritis, gout, psoriatic arthritis), tendon inflammation, finger injuries and complex regional pain syndrome. Carpal tunnel syndrome is a nerve entrapment that can cause numbness in the hand and fingers. In suitable patients, options such as a night splint may be considered.
Treatment and prevention
Treatment is based on rest, medication, physical therapy, exercise and local injections; in inflammatory cases, antirheumatic drugs can reduce inflammation. Heat or cold application, paraffin therapy and contrast baths may ease symptoms. Avoiding repetitive and strenuous hand movements, taking frequent breaks during detailed work, keeping the wrist in a neutral position when writing, using tools with thick handles and, where needed, a wrist support or splint can help with prevention.
Why are we asked about the distribution of numbness?
Which fingers are numb, whether the numbness worsens at night, and symptoms such as dropping objects all help in assessing the nerves. Repetitive work can also strain the tendons. Joint swelling, morning stiffness and symptoms radiating from the neck are taken into account in the differential assessment.
Adjusting work and everyday use
How the wrist is used at the keyboard, with hand tools, with a phone or when carrying is examined. Where needed, breaks in work, reduction of load and suitable splint options are discussed. The purpose of the splint and how long it is to be worn must be established; leaving the wrist immobilised for long periods without supervision can adversely affect function.
Your questions
Patient information
Is every case of finger numbness carpal tunnel syndrome?
No. Other nerve entrapments and problems arising from the neck can also cause numbness. Where needed, the assessment is supported by EMG.
Should mild wrist pain after a fall be taken seriously?
Some fractures may not be obvious at first. If there is persistent pinpoint tenderness, swelling or an inability to use the wrist, examination is needed.
