Why is My Hand Painful?

Our hands are used almost unconsciously to get things done whether at work or at play. We seldom think about them until something is not quite right, and even then, we often push it our of mind until it becomes an obstacle to using our hands properly.
Some conditions can cause slowly progressing or chronic pain in our hands in the absence of any injury. Most can be treated and cured if diagnosed early; but if left untreated these conditions may cause significant disability. Three of the most common chronic painful hand conditions and their treatments are discussed.

Common chronic Painful Hand Conditions:

Trigger Finger

Trigger finger is one of the most common painful conditions of the hand between the ages of 40 to 60. Along with pain, the affected fingers or thumb also become stiff and may “lock” when fully flexed. Straightening the fingers is difficult and accompanied by a clicking sensation. In more severe cases, one may have to use the other hand to pull the finger straight. The finger is especially stiff and prone to to locking just after waking in the morning. This condition is caused by a combination of repetitive stress on the flexor tendons of the fingers and ageing. The flexor tendons go through a tunnel along each finger. As we age, microscopic damage caused by daily friction between the tendons and the tunnel accumulates. The opening of the tunnel becomes thicker and tighter, making it more difficult for the tendon to move the finger. When the tendon gets stuck, the finger locks. The most reliable treatment is surgery to divide the tight opening of the tunnel, allowing the tendon to move freely again. Steroid injections to the tunnel are also useful, but there is a 30% chance that the condition will recur after an injection.

Trigger Finger Video

DeQuervain’s Tenosynovitis

De Quervain's Disease

This is an inflammation and tightness of the tendons going across the wrist to the thumb caused by overuse. Young mothers are very prone to this due to hormonal changes, inexperience with carrying a baby for breastfeeding, and having to hand-wash a lot of baby clothes. Office workers who use a keyboard and mouse for long hours with poor hand and wrist posture are also prone to this. The use of tablets and smartphones requiring a lot of thumb movements to type messages is nor also becoming common cause. This condition causes pain along the border of the thumb going into the wrist and the forearm, particularly with thumb and wrist movements. Simple actions like opening doors or bottles, brushing teeth, tying hair or hooking a bra can become impossible because of the pain. Even typing on a keyboard is painful when the thumb is used. In the early stages, resting the thumb and wrist in a splint or brace and taking anti-inflammatory tablets may cure the problem. However, once it has been present for more than a month, an anti-inflammatory injection to the tendons is needed. Most, importantly, long-term changes in the way the hand and thumb are used are essential to prevent the condition from recurring. If the injection doesn’t work or the pain keeps coming back, then surgery is needed to release the tendons from their tunnel at the wrist.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

This is caused by excessive pressure on the median nerve as it goes across the wrist into the hand. The median nerve is the main nerve providing sensation in the hand and control of the thumb muscles. Along with the flexor tendons to the fingers, this nerve goes through a tunnel at the wrist, consisting of the wrist bones and a thick band of fibrous tissue across the top. The pressure in this tunnel increases as we grow older due to thickening of the tendons from repeated daily use. Other conditions such as wrist fractures, gout, and tumours may also increase the pressure in this tunnel. The increased pressure decreases blood flow to the nerve, impairing its function, resulting in numbness, tingling, and burning pain in the hand.

Symptoms are usually worse the morning on waking up, and sometimes can wake you from sleep. If left untreated, the nerve may become permanently damaged, with decreased sensation in the fingers and weakness of the thumb. Mild cases may resolve with resting in a splint, doing exercises for the nerve and taking high potency supplements. However, the best treatment is most cases is to decompress the nerve by cutting the band of tissue going across it. This is now done via keyhole or endoscopic surgery under local anaesthesia. Symptoms usually disappear within one to two weeks if operated on before permanent nerve damage occurs. In severe cases with permanent damage, recovery of lost function may be poor even with surgery, but surgery will prevent worsening function.

Timely surgical management can cure those common painful hand conditions

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