Hand Pain Issues
Hand pain can be caused by a number of issues including Hand Arthritis, Carpal Tunnel Syndrome, Trigger Finger or a scaphoid fracture.
Hand arthritis
Hand arthritis is more common than people appreciate centred on the basal thumb, trapeziometacarpal and scaphotrapezial joints. This is associated with a systemic inflammatory osteoarthropathy referred to as Heberden’s disease. It affects the proximal and distal interphalangeal joints producing local bony spurs. It is often confused with Rheumatoid arthritis. There is a strong association with knee ( patella femoral ) and metatarsal, big toe, joint arthritis.
Treatment options include localise splintage, joint injection and trapezial joint replacement using split flexor carpi radialis tendon interpositional arthroplasty. Artificial joint replacement is also available.
Pan carpal arthritis usually due to Rheumatoid or seronegative disease may affect the metacarpal and interphalangeal joints. Individual joint replacements remain an option. Proximal wrist fusion is sometimes indicated.
Dupuytren’s disease
Dupuytren’s disease is a progressive condition that causes finger flexion deformity centred on the ring and little finger. Patients will develop pretendinous cords which progressively flex the fingers in. There is a genetic association and risk factors include vibrating tools, trauma, and low oxygen exposure.
Treatment include wearing splints, hand therapy with stretches/massage, Clostridium histolytica injection and excision of the cords depending on the severity and location. It is prone to recurrence and may require further surgery. Very rarely dermafasciectomy is indicated.
Carpal tunnel syndrome
Carpal tunnel syndrome is a common condition with awareness of palmar hand pain associated with tingling in the index, middle, and thumb. It is open bilateral. It may be associated with underlying neck complaints referred to as “double crush”.
It will progress over time causing nighttime pain and progressive numbness. The patient will shake the hand for relief and periodically elevate. The fingers may appear to swell. It may be associated with forearm/wrist tenosynovitis.
Risk factors include Diabetes, pregnancy, trauma and inflammatory arthritis. It is frequently idiopathic. It can be classified as mild/moderate to severe depending on the level of nerve compression injury. The more severe the classification, the poorer the electric conduction on nerve studies.
Diagnosis is based on findings of a positive Tinel’s, positive Phalen’s and measurement of reduced two point sensory discrimination. Reduced abductor pollicis brevis power may be noted. Hand x-rays often show basal thumb arthritis. Nerve conduction/EMG studies are important, as the condition may deteriorate silently.
Nighttime wrist splintage is attempted initially with anti-inflammatory medication. Carpal tunnel injection may help. Carpal tunnel decompression is a well proven treatment option. This is undertaken through a small wrist incision under microscopic guidance.
Other Causes of Hand Pain
Trigger finger is a condition associated with tenosynovitis and underlying carpal tunnel/basal thumb arthritis. It can be treated by injection or open surgery.
Scaphoid fracture is a common basal thumb injury that is frequently missed. It is often caused by sport. It is essential that dedicated scaphoid x-rays are undertaken possibly supplemented by CT/MRI. Treatment usually is conservative in cast and may require internal fixation with Herbert screw or similar. Occasionally, delayed diagnosis may cause scaphoid non-union requiring bone grafting.