As the global human life expectancy advances, the presence of pain in body areas of greatest use becomes more likely. The longer we live the more likely we will have pain. Persistent pain in the hands requires that a specific cause for the pain be identified and treated to improve quality of life and function.
The prevalence of persistent hand and wrist pain ranges from 3% to 26% of the general population. This would mean that upwards of 80 million Americans suffer from persistent hand or wrist pain. Certain occupations and life styles can place a person at risk for developing this syndrome.
This post will examine the most common hand pain causes. The diagnosis of hand pain is not usually difficult…it is the treatment that can rather frustrating.
The hand is a compacted structure of musculo-skeletal anatomy. The majority of grasping and fine finger movement of the hand is powered by forearm muscles located some distance from the hand. The motor power is connected through a complex array of cables called tendons.
The movement of this cable network requires the generation of a great deal of friction. The friction is minimized by sliding the tendons through well lubricated coverings called tendon sheaths. Any distortion of the tendon or covering changes the frictional coefficient and can cause pain.
The blood and nerve supply to the hand also comes from the forearm into the hand through the wrist. There is an anatomical narrowing at the wrist through which the blood and nerves must pass. Any distortion of the compact narrowing at the wrist can affect the blood and nerve supply to the hand.
The central nervous system directs the function of the hand. The amount of neurons assigned to this task is considerable given the complexity of the movements of the hand. Central nervous system disease can severely affect the function of the hand (even in the absence of any direct hand abnormality).
Proper evaluation of hand pain causes requires the examining clinician to be well acquainted with the complicated anatomy of the wrist and hand. Understanding this anatomy makes the diagnosis of chronic hand pain well within the scope of most primary care practitioners.
Physiology of the Hand
It stands to reason that, once understanding the anatomy of the hand, the causes of chronic hand pain can be elucidated. The causes of hand pain can be broken down into 7 basic types:
- Disorders of nerves
- Disorders of blood flow
- Disorders of ligaments
- Disorders of tendons
- Disorders of bones
- Disorders of joints
- Disorders of skin and soft tissue
For the purposes of this post we will be confining our discussion to disorders of joints, tendons, and nerves. The volume of information and potential disorders that can occur with the hand precludes an in-depth discussion of all possibilities in a post of this length.
Joints can be affected by a loss of cartilage (Osteoarthritis), inflammation of the joint (Rheumatoid Arthritis), direct trauma, abnormal tissue growth (such as tumors), abnormal blood supply, and abnormalities of the nervous input to the joint. Tendons are subject to nearly the same risks.
Nervous system abnormalities can occur through central and peripheral diseases. At times, the dysfunction may be quite remote to the hand but effects the hand enormously (such as in a stroke).
Now that you have a basic understanding of hand anatomy and physiology you are prepared to understand several basic hand pain causes.
Causes of Hand Pain
The hand is particularly vulnerable to the “wear and tear” of life. Because of this the most common form of arthritis of the hands is Osteoarthritis.
Essentially a wearing away of cartilage on the joints of the hand, OA causes pain and disfigurement of the last joint of the fingers. Other finger joints can be involved too, but the most characteristic changes occur in the last joint. These are called Heberden’s nodes (see picture).
People who use their hands for intense activities will develop OA more readily. Though there is a genetic tendency in certain families, joint stress is a major risk factor for OA.
The autoimmune process that occurs in Rheumatoid Arthritis also gives a characteristic appearance to the hand effected by it. The disease process in RA inflames the membrane inside the joint (synovial membrane) causing the release of destructive substances.
The destructive substances primarily affect the joint surface but can also effect all the other local structures adjacent to the joint (for instance, tendons and ligaments). The deformity that occurs is also quite characteristic as the hand cycles through many phases of inflammation and healing between acute episodes.
Carpal Tunnel Syndrome (CTS):
Although not a joint specific disorder, CTS is a major cause of pain and disability of the hand. The disorder is essentially one of compression of the Median Nerve which traverses the wrist enroute to the hand.
Any process that causes narrowing of the aperture through which the Median Nerve traverses, the Carpal Tunnel of the wrist, can cause CTS. The disease process is one of nerve pain and can be very discomforting (see picture).
The treatment of these 3 disorders requires general pain treatment as well as having some specific features.
Hand Pain Treatment
- Carpal Tunnel Syndrome (CTS): As is true of all disorders, reversing the primary mechanism of the disease process is the best treatment. In the case of CTS, relieving the compression of the Median Nerve remains the definitive treatment. I have written extensively on this subject in a previous post (click here to see my post on Options for Carpal Tunnel Syndrome).
- Osteoarthritis (OA): As the primary disease process is one of loss of cartilage on the joint surface, replacement of the cartilage of finger joints is not possible at this juncture. However, tremendous relief can be achieved with pain medications, anti-inflammatories, and natural pain relievers (such as Turmeric). I have written extensively on Turmeric in a previous post (click here to see my post on Turmeric Benefits Arthritis).
- Rheumatoid Arthritis (RA): The inflammation in the autoimmune process of RA is much better treated today than when 1980s. Beginning with the general arthritic treatments (pain medication, anti-inflammatories, etc.) therapy may need to be advanced to an exciting category of medicines called Disease Modifying Agents (DMA) (Click here to see my post on Rheumatoid Arthritis Treatment).
DMA therapy reduces the actual process of autoimmunity in the person with RA and has resulted in a much more favorable prognosis. This type of therapy is usually administered by a specialist in RA called a Rheumatologist (specialist in arthritis).
I have reviewed the basic anatomy, physiology, and major hand pain causes. I hope you have enjoyed this post. If you have further questions or comments please send it below. I would love to hear from you. My response will be prompt.
I wish you much joy and good health.