Pain in the hand
Pain in the hand indicates the presence of a pathological process in the bones and soft tissue structures of the distal upper limb. Sensations vary significantly in nature and duration, can be weak, intense, acute, dull, prolonged, short-term. Sometimes there is a connection between pain and physical exertion, other factors. To clarify the diagnosis, a survey, physical examination, radiography, CT, MRI of the hand, and other diagnostic procedures are carried out. Before determining the cause of pain, rest is recommended, sometimes taking analgesics is allowed.
Causes of pain in the hand
Traumatic injuries
Soft tissue diseases
Dermatological problems
Infectious processes
Arthrosis
Other joint diseases
Tumors
Neurological causes
Other reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain in the hand
Traumatic injuries
Bruising of the hand occurs as a result of a blow or fall, manifested by moderate gradually subsiding pain, swelling, slight limitation of limb function. Bruises and abrasions are possible. On palpation, local soreness is noted, the symptom of axial load is negative. All manifestations disappear after 1-2 weeks.
Fractures of the II-V metacarpal bones are formed when a fist is struck, falling on a fist. V injuries predominate, sometimes in combination with a fracture of the IV metacarpal bone. Injuries of the II, very rarely – III metacarpal bone are less common. Fractures are manifested by sharp pain, which almost does not subside over time. The hand is swollen, especially in the projection of the damaged bone, often deformed. When palpation is determined by crunch, pathological mobility. The function is drastically reduced.
With a fracture of the I metacarpal bone, the diaphysis or the base of the bone suffers. In the first case, the maximum soreness is found in the central part of the tenar, in the second (with a Bennett fracture) – just above the wrist joint. Bennett’s fracture is accompanied by displacement of the distal fragment of the metacarpal bone, external deformation of the base of the tenar. An active grip with the participation of the I finger is impossible, when you try to squeeze your hand into a fist, to oppose the I finger, the pain increases dramatically.
Fractures of the wrist bones are less common. Swollen mainly the base of the brush. Depending on the type of fracture, the pain is localized:
navicular bone – from the side of the I finger, increases with pressure on this finger;
semilunar bone – in the middle part of the hand, increases with axial load on the III and IV fingers;
the pea–shaped bone is on the side of the V finger, it grows when trying to bend the little finger.
Dislocations of the wrist bones are often combined with fractures, manifested by extremely intense pain, significant swelling, pronounced deformation of the hand. The functions of the hand are almost completely lost due to severe pain syndrome.
Soft tissue diseases
For de Quervain’s disease (stenosing ligamentitis), painful sensations in the area of the wrist joint are more typical, but in half of the patients, aching or pressing pain also occurs in the area of the tenar, radiates into the thumb. At first, the pain syndrome is detected only with excessive withdrawal and extension of the first finger, then it begins to bother with any movements, sometimes it remains at rest.
Aseptic tendovaginitis of the tendons of the fingers of the hand begins acutely against the background of overload, manifests itself as a constant pulling pain that increases with finger movements, accompanied by limited movements, blurred swelling, hyperemia. With the chronization of the process, the intensity of pain decreases, they are observed only under load, patients complain of a feeling of a reduced brush.
Hygromas are more often formed on the back of the wrist joint, but they can also be located on the palm side of the hand. Initially, they are usually painless, with active brush movements, pressure of a solid object, minor or moderate pain may occur. Unlike formations of other localizations, palmar hygromas differ in significant density, they can resemble bone outgrowths.
Pain in the hand
Pain in the hand
Dermatological problems
A water callus forms on the palmar surface in the area of the heads of the metacarpal bones, is a consequence of unusual or too long work with the tool. At first, there is an indistinct local soreness, slight swelling, redness. Then a bubble forms on the palm, the pain becomes intense, twitching, stabbing, cutting, intensifies with movements, touch. After opening the bubble, a painful wound appears.
When a wound is infected or microbes enter the bladder through cracks in the skin, a callus abscess develops with rapidly increasing pains that take on a twitching, pulsating character. The pain bothers at night, increases with pressure, lowering of the hand, accompanied by a slight increase in temperature, swelling of the back of the hand. When the pus breaks into the surrounding tissues, the condition worsens even more, the pain becomes diffuse, weakness is noted, the temperature reaches febrile figures.
Infectious processes
Boils and carbuncles in the area of the hand are rarely formed, are more often detected in men, are located on the back surface of the segment. They are accompanied by increasing local pain, which for several days becomes very intense, bursting, tugging, deprives of a night’s sleep. An external examination reveals a limited purulent focus with a diameter of up to several centimeters of bluish-purple color with one or more necrotic rods.
Phlegmons of the hand are usually a complication of panaritium, infected wounds and abrasions. Accompanied by strong twitching spilled pains, sleep deprivation, preventing any movement of the brush. Weakness, hyperthermia, symptoms of intoxication are noted. The swelling is more pronounced on the back side, a cushion-like seal is determined on the palm, the fingers fan out to the sides.
Hematogenous osteomyelitis rarely affects the bones of the hand, post-traumatic and postoperative forms of the disease are more typical for this localization. Pathology is manifested by the appearance or intensification of pain syndrome, progressive edema, hyperemia, deterioration of the general condition, weakness, hyperthermia. The pain is sharp, jerking, tearing, clearly localized, so strong that the patient avoids any movement of the limb.
Arthrosis
Risarthrosis of the 1st finger (arthrosis of the 1st metacarpal joint) is manifested by pain at the base of the thumb. Initially, the pain is short-term, it appears at the beginning of movements and after the load. Subsequently, the duration and intensity of the pain syndrome increase. The joint is deformed, the juxtaposition of 1 finger is violated, which entails a limitation of the function of the limb.
After single gross injuries or repeated microtraumas, arthrosis of the wrist joints develops with a carpal rearrangement of the bone tissue. At the initial stage, patients complain of heaviness in the hands, awkwardness of the hands, short-term tingling pains without a clear localization. Then the symptoms become permanent, after the breakthrough of cysts are replaced by acute pain, swelling and dysfunction.
Other joint diseases
With rheumatoid arthritis, the interphalangeal joints are usually affected at first, then inflammation in the metacarpal joints joins. Along with pain in the fingers, soreness is noted in the distal parts of the hand and the wrist joint. The pain is periodic at first, then prolonged, combined with morning stiffness. Palpation of the hands is painful, “rice bodies” are often felt. In the later stages, gross deformations are detected.
Arthritis with polymyositis is detected in 15% of patients, characterized by soreness in the joints of the hand and fingers. The pain is moderate, dull, aching, periodic, combined with swelling, redness, restriction of movement, calcification. Deformations are usually absent. The main manifestation of the disease is muscle pain and muscle weakness.
Hydroxyapatite arthropathy is characterized by constant dull pain, increasing at night, morning stiffness, slight swelling of the joints. There may be manifestations of tenosynovitis or a course like carpal tunnel syndrome with shooting pains in the palm area, radiating into the fingers and forearm. Deformations are not formed.
Tumors
The bones of the hands are more often affected by benign neoplasia – osteoid osteomas and chondromes. Osteoid osteomas are accompanied by sharp local pain, less often they are asymptomatic. With chondromes, the pain is indeterminate, indistinct, non-intense, slowly progressing as the neoplasm grows. Malignant tumors for the hands are uncharacteristic.
Neurological causes
When the nerves are affected, the pain in the hand is burning, shooting through. Often spread to other parts of the limb, combined with muscle weakness, trophic disorders, sensitivity disorders. They are detected in the following conditions:
Neuropathy of the median nerve. Painful sensations are often causalgic in nature, localized in the radial half of the palm, the tenar region.
Neuropathy of the radial nerve. Patients are concerned about burning pains on the back of the hand, which can radiate into the fingers, shoulder and forearm.
Ulnar nerve neuropathy. The pain syndrome is detected along the elbow edge of the palm, spreads from the elbow joint along the forearm to the fingers.
Carpal tunnel syndrome. Shooting pains, tingling are noted on the palm surface of the hand from its radial side. Possible irradiation in the forearm and fingers.
Pain in the hands can also occur with some neurotrophic pathologies: shoulder-hand syndrome, anterior stair muscle syndrome, cervical-rib syndrome. Pain in the distal part of the upper limb is characteristic of cervical osteochondrosis, intervertebral hernias, spondyloarthrosis, and other diseases of the spine.
Other reasons
Professional neuroses, some neurological and mental pathologies are accompanied by the appearance of a writing spasm – pulling, aching pains in the hand that occur when writing, typing from the keyboard, combined with convulsions, trembling, weakness of the distal parts of the limb. In addition, pain in the projection of the hand is observed in the following pathologies:
Myocardial infarction. Chest pain often radiates into the arm, including the hand and fingers.
Post-infarction condition. In every fifth patient with a heart attack, pain and paresthesia of the hand due to neurotrophic disorders are detected in the long-term period.
Diseases of the veins. Thrombophlebitis, varicose veins, postthrombophlebitis syndrome in some cases develop after intravenous injections into the veins of the back of the hand.
Diagnostics
Determination of the causes of the pain syndrome is carried out by traumatologists-orthopedists. To make a diagnosis, the results of a survey, physical examination, instrumental and laboratory techniques are used. Can be assigned:
Radiography of the hand. Performed in 2 or 3 projections, it makes it possible to diagnose fractures, dislocations, arthrosis, arthritis, osteomyelitis, neoplasms.
CT of the brush. It is more informative when studying solid structures. It is recommended for complex fractures and fractures, arthritis, arthrosis, osteoporosis. Allows you to accurately localize the area of damage, assess the nature and prevalence of the pathological process.
MRI of the hand. It is indicative in the study of soft-tissue formations. It is prescribed to study the condition of muscles, ligaments, tendons, blood vessels, nerves. It is used for tendinitis, arthrosis, arthritis, purulent processes, tunnel syndrome.
Electrophysiological techniques. They are used for the neurological cause of pain in the hand to determine the level of nerve damage, assess nerve conduction, and the condition of muscle tissue.
Laboratory tests. They are performed to identify signs of inflammation, specific markers, assess the activity of various organs in systemic pathologies, study the structure of tissue during histological or cytological analysis.
To make an accurate diagnosis, a specialist examination is required
To make an accurate diagnosis, a specialist examination is required
Treatment
Help before diagnosis
Fractures and dislocations are fixed with a tire, cold is applied. For all injuries and diseases accompanied by edema of the limb, an elevated position of the hand is recommended. With intense pain, an analgesic is given. In most cases, the pain syndrome decreases at rest, so patients are advised to reduce motor activity (except in cases when the pain passes during movement). With increasing acute pain, hyperthermia, intoxication, an urgent consultation with a doctor is indicated.
Conservative therapy
In case of dislocations and fractures, local anesthesia, reduction, fixation with a plaster bandage are performed. Patients with injuries and diseases of the hand are prescribed:
Protective mode. The patient may be recommended immobilization with a plaster or kerchief bandage, the use of orthoses, load limitation.
Drug therapy. For arthritis, arthrosis, and some other pathologies, NSAIDs are used, for infectious processes – antibiotics, for neurological disorders – neurometabolites. While maintaining an intense pain syndrome, blockades with glucocorticoids are performed.
Non-drug methods. Massage, physical therapy, physiotherapy procedures, including electrophoresis, UHF, mud therapy are carried out. Laser therapy, magnetotherapy, and other techniques are successfully used.
Surgical treatment
Taking into account the peculiarities of pathology , the following surgical interventions can be carried out:
Traumatic injuries: fixation of the metacarpal bones with spokes, open osteosynthesis of the navicular bone, open reduction of dislocation of the semilunar bone.
Infectious processes: opening of corn abscesses, boils, carbuncles, phlegmon of the hand, sequestrectomy for osteomyelitis.
Neurological diseases: nerve decompression.
Neoplasms: excision of the tumor, bone resection.
Consequences of diseases and injuries: arthrodesis of the carpal joint, bone grafting of the navicular bone.
In the postoperative period, bandages are performed, painkillers and antibacterial agents are prescribed. They make up comprehensive rehabilitation programs, issue referrals for sanatorium-resort treatment.
