Hand and Wrist Pain

What is Hand and Wrist Pain?

In an age of computers Hand and Wrist Pain is quite common. Our wrists, hands, and fingers are delicate, yet they can be very powerful. Our hands are made up of bones, joints, soft tissues, and nerves that travel down the arm to the wrist, hand, and fingers. Collectively they work together to provide sensation as well as gross and fine motor movements. In other words, we can feel, touch, hold, grasp, and pinch with our hands. All critical functions to help us with our daily lives.

Some simple facts to prove just how complex yet delicate our hands are, below is the approximate number we have in each of our wrists, hands, and fingers:

  • 29 bones
  • 29 joints
  • 23 ligaments
  • 34 muscles
  • 48 nerves
  • 30 arteries

In fact, the thumb alone has nine muscles that control its movement. The hand has three main nerves, and it takes all three nerves to help power the thumb. That’s pretty amazing!

We rely on our hands to help us accomplish a lot every single day. Unfortunately, hand pain is common and may affect our ability to perform our daily activities successfully. Pain and injuries can be caused from repetitive wear and tear to a traumatic injury. To understand the delicate balance between bones, soft tissue, and nerves, and how that relates to function, some understanding of basic anatomy is critical.

Two bones from the forearm, the ulna (little finger side) and the radius (thumb side), connect with the grouping of 8 wrist bones. Collectively these wrist bones are called the carpus. The wrist bones essentially make up two compact rows. The row of bones closest to the ulna and radius (proximal) are the hamate, capitate, trapezoid, and trapezium. The top row of wrist bones (distal) includes the pisiform, triquetrum, lunate, and scaphoid.

In the middle of the hand, the palm area, the bones are called metacarpals. There are five metacarpal bones, each extending from the wrist bones to the fingers, also called phalanges. Each finger consists of 3 phalanx bones except the thumb only has two. In total, we have 14 phalanx bones in our fingers and thumb.

When two bones come together, they form a joint. Each phalanx, or finger, has three joints based on their proximity to the body. The metacarpophalangeal joint (MCP) is your knuckle bone at the base of your finger. The proximal interphalangeal joint (PIP) is the joint in the middle of your finger. The distal interphalangeal joint (DIP) is the last joint, furthest from the body, of the finger.

The thumb also has three joints, except the base of the joint of the thumb is called the carpometacarpal joint (CMC), which is where the phalanx connects with the wrist or carpus bones. The thumb also includes the metacarpophalangeal joint (MP) which is in the middle of the thumb. And finally, the interphalangeal joint (IP) which is at the tip of the thumb.

The CMC joint is the most vulnerable to injury. The CMC is at risk for arthritis as well as tendon issues, called de Quervain syndrome, which is a more common condition today due to the frequency and repetitive nature of texting.

To help our joints and bones move, we use our muscles and tendons of the forearm, wrist, and hand. Muscles are flexible and powerful; they connect to the bones by way of tendons. Tendons are fibrous connective tissue that can withstand a lot of pulling forces on both ends. The six main tendons in each hand are:

  • Abductor pollicis longus and extensor pollicis brevis-runs from the top of the forearm to thumb; aides with thumb movements
  • Extensor-runs from the top of the forearm to the back of the hand; aides with extending the wrist and straighten the fingers
  • Flexor-runs from the bottom of forearm to each finger including the thumb; aides with flexion
  • Profundus-flexes the wrist, MCP, PIP and DIP joints
  • Superficialis-flexes the wrist, MCP and PIP joints

Within the wrist and hands, we also have ligaments. Ligaments connect bone to bone with the main function of “stabilizing” the joints, which means ligaments are tough fibrous tissue whose main purpose is to prevent unwanted movement within the joint space. The six main ligament types in each hand are:

  • Collateral-run along the sides of your finger to prevent sideways movement of joints
  • Dorsal radiocarpal-ligaments on the backside of the wrist
  • Radial and ulnar collateral-ligaments on the backside helping hold the wrist bones together
  • Ulnocarpal and radioulnar– set of main ligaments supporting the wrist bones
  • Volar plate-prevents PIP joint from hyperextending; palm side between MCP and PIP
  • Volar radiocarpal-ligaments webbed together on the palm side of the hand

Bones, tendons, and ligaments provide structure, movement, and stability. The brain communicates with the hand on movement and sensation via nerves. We have many nerves in our hand; however, there are three main nerves that come from the brachial plexus-ulnar, radial, and median nerves.

The ulnar nerve runs along with the inside of the elbow, down the forearm, and to the medial side (pinky) of the hand. The ulnar nerve helps with hand and wrist flexion and provides sensation to the middle of the palm, ring, and pinky fingers.

The radial nerve runs along the backside of the forearm and hand. This nerve communicates functions related to wrist and extension. It also provides sensation to the back of our hands.

The median nerve provides the function of wrist and finger flexion. It also provides sensation to the palm, thumb, index and middle fingers. The space within the bones of the wrist, or carpus, form a tunnel where the median nerve passes. With repetitive movements, compression, or wear and tear, inflammation occurs compressing the median nerve, which is the most common form of nerve injury in hands and it is called carpal tunnel syndrome.

What causes hand and wrist pain?

The wrist is purposefully designed to be complex. The bones, soft tissue, and nerves within our hands allow for sensation and movement to the finest degree. With a complex design, that can lead to numerous causes or reasons for hand and wrist pain. The following list are the most common forms of hand pain, but it certainly is not an all-encompassing list:

  • Boutonniere deformity-the PIP flexes towards the palm, and the DIP extends upward
  • Brachial plexus-nerve bundle exiting the neck which goes down the arm to the hand; one or multiple nerves can be pinched, compressed, or irritated
  • Carpal tunnel syndrome (CTS)-compression of the median nerve
  • De Quervain’s disease-tendon in thumb because inflamed
  • Diabetes-may affect sensation of the hand
  • Dislocation-a joint within the hand is no longer in alignment
  • Dupuytren’s disease-thickening of soft tissue, including tendons, of the palm which limits movement of flexor tendons
  • Fracture-broken bone
  • Frostbite-skin and tissue is damaged due to exposure to extreme cold
  • Ganglion cyst-fluid filled sacs that are harmless but can get in the way of normal movements of wrist and hand
  • Infection-bacteria is present from either an internal or external cause
  • Laceration-a knife, or some other sharp object, cutting through soft tissue (muscles, tendons, and ligaments)
  • Lupus-autoimmune disease affecting joints and soft tissue of hand
  • Mallet finger-the tip of the finger sags as the extensor tendon of the DIP is severed
  • Osteoarthritis-a breakdown in the cartilage between joints
  • Rheumatoid arthritis-autoimmune disease that can be very painful and cause deformity of the joints
  • Raynaud’s phenomenon-blood vessels are severely constricted with extreme temperatures or stress; this condition cause a purplish discoloration of fingers due to lack of blood supply
  • Repetitive motion-pain and swelling with repetitive movements
  • Tenodesis-breakdown of fibers in tendons
  • Traumatic incident-stab wound, puncture, gun shot, amputation
  • Trigger Finger-flexor tendon swells
  • Writer’s cramp-muscle spasms from repeated pinching, gripping, typing

Symptoms of Hand and Wrist Pain

Depending on the severity of the injury, hand symptoms range from mild pain and stiffness to severe pain and loss of range of motion. Swelling, discoloration or joint deformity may be a sign of a more severe problem. If there is an injury to a nerve or nerves, loss of sensation, numbness or tingling may occur. Listed below are symptoms related to various hand and wrist conditions:

  • Brachial plexus-numbness, tingling, and weakness within a certain distribution of the hand (depending on which nerve is injured)
  • Carpal tunnel syndrome- pain in the wrist and palm side of hand coupled with weakness, tingling, or numbness
  • De Quervain’s-pain on the back side of the thumb around the CMC joint, pain with gripping or while texting
  • Diabetes-sensation may be diminished, mild to moderate pain
  • Dislocation-swelling, possible redness or bruising, immobility, and deformity of the joint injured
  • Fractures-swelling, redness, stiffness, and loss of range of motion
  • Frostbite-loss of sensation, severe pain, discoloration whitish to black
  • Infection-warm, red or red streaking, swelling, and possibly a fever
  • Osteoarthritis-enlarged joint, stiffness, and pain
  • Raynaud’s phenomenon-fingers turn purplish in color when cold, pain or discomfort
  • Rheumatoid arthritis-deformity of the joint, pain, redness, swelling
  • Sprain or strain-muscles, tendons, or ligaments overstretched or torn
  • Trigger finger-overtime, progressive stiffness at the joint with eventual inability to extend the joint

Seek medical attention for the following symptoms:

  • Deformity of the joint
  • Discoloration, whitish color, after begin out in the cold
  • Loss of sensation
  • Numbness or tingling that lingers, or doesn’t go away
  • Numbness in hands coupled with pain in the chest, middle of the back, and/or down the left arm
  • Progressive redness and swelling
  • Red streaking
  • Warm joints

How is hand and wrist pain diagnosed?

Diagnosis varies greatly depending on the type of injury. Unless a traumatic injury occurs, it takes investigative work by a health care provider such as a physician, physical therapist (PT), or occupational therapist (OT).

A physical exam of the neck, elbow, wrist, and hands is necessary to determine the cause of the symptoms. Also, your health care provider will review your medical history, ask for the onset of symptom details, and review your daily activities include work, hobbies, and sleeping habits.

If needed, your physician may order imaging such as an X-Ray or MRI (magnetic resonance imaging), blood work, or an EMG (electromyogram). Imaging is needed to fully assess the condition of your bones, joints, and soft tissue. Your physician is looking for proper alignment of the joints, good joint space, and assessing if soft tissue is properly attached and in good condition. Blood work may be drawn to further assess for infection or an autoimmune disease such as rheumatoid arthritis. EMGs ordered to determine damage to the nerves.

Traumatic injuries need immediate medical attention. Imaging is likely to determine how much damage is done to the bones, joints, soft tissue, and nerves. The best course of action will be determined based on the state of emergency of the injury.

Treatment of Hand and Wrist Pain

Treatment will vary depending on the diagnosis; early intervention is key to conservative care. For acute, non-traumatic, injuries, resting your hand from strenuous activities and icing may be all the care that is needed.

If hand or wrist pain does not go away or worsens over time, seek care from a hand therapist, like a PT or OT. In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

A few conservative treatment approaches by your PT or OT may include:

  • Inflammation and swelling management (e.g. soft tissue mobilization and/or iontophoresis)
  • Gentle range of motion exercises
  • Splinting to assist with minimizing or eliminating movement
  • Strengthening exercises

Depending on the diagnosis, sometimes a more aggressive treatment approach is needed to manage symptoms. For example, Dupuytren’s if treated early may only need a PT or OT to stretch, strengthen, and apply a splint to prevent further deformity. If not treated early enough, or in some stubborn cases, an injection or surgery may be indicated.

For traumatic injuries, such as a dislocation or amputation, immediate medical attention is important in preventing further damage.

Next Steps

Early intervention to hand pain is important for successful conservative intervention. Not all hand conditions can be treated conservatively. For non-traumatic and generalized symptoms, conservative care is the best place to start.

As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

To get started with conservative care today, you can find a highly qualified PT or OT in your area. There are many qualified PTs and OTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT or OT that has top national rankings for treating hand pain.

For traumatic injuries or severe symptoms, immediate medical attention by your physician is recommended.

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