Sunday, April 1, 2012

Wrist and hand pain

Physical activity is a good way to feel better, get fit and beat pain. You can start your own home with simple free exercise videos for everybody, Tv-Gym.com.


Stress Injuries

The hand is a versatile tool. It is strong and able to handle extremely small size objects and to perform tasks that require extreme precision. There may not be another tool as versatile around. Only when we experience problems do we begin to understand and appreciate the daily functioning of the hand.

It is fairly common to have stress injuries in the elbow and wrist areas. These are usually caused by repetitive work or doing crafts requiring repetitive motions. If a cracking sound is connected to the painful sensation, which usually means tendovaginitis which warrants seeing a doctor. Reducing stress and optimizing work posture usually improve the situation. If this doesn’t solve the problem, a doctor can prescribe anti-inflammatory medicine in oral or ointment form as well as physical therapy.

Self-treatment consists of over-the-counter anti-inflammatory medication and ointments for a few days to alleviate the pain. Cold compresses are not recommended for fingers. If the problem is tension in the forearm muscles it could be helpful to stretch so that the elbow is straight and the wrist is stretched toward the palm and the top of the hand.

Avoiding undue stress on hand at work and during leisure is wise. In case of wrist problems, work or hobbies that require repeated extreme positions and movements of the wrists should be avoided. When working with a mouse, the other healthy hand should be used instead of the sore hand.

When working at a computer, several short breaks should be taken during the day. It is advisable to do short gymnastics; for example lifting hand up, tensing all the muscles and then relaxing them, followed by shaking the hand.

There must be enough space in front of the keyboard to place both hands, so there is no additional unnecessary tension of the muscles of the upper arms. A wrist support may be used to support the hands on it while typing.


Carpal Tunnel Syndrome

The most common question regarding the hand is pressure on the median nerve in the carpal tunnel, the carpal tunnel syndrome. It is quite common in people who type a lot or play certain musical instruments daily as well as in those who overexert their wrists, use vibrating tools or have to perform repetitive motions of the hand and wrist all day long. Illnesses such as rheumatism, arthritis of the wrist, fractures in this area, or obesity causing the carpal tunnel to shrink may enable this condition. Also diabetes, hypothyroidism, kidney failure, menopause, pregnancy, infections and alcoholism can make the nerve more vulnerable to pressure and easily irritable.

The median nerve innervates the thumb side of the hand. In its problems, both feeling and movements may suffer. The initial symptoms include numbness and burning in the first three fingers. This is usually at its worst at night, and symptoms may cause the patient even to wake up. Shaking the hand or lifting it up may help. There often is also pain in the wrist or hand and some problems with precise finger movements. A weak grip and weakness of the hand may manifest itself as a difficulty to carry bags. If the symptoms are not alleviated, muscle weakness in the hand close to the thumb may develop.

In doctor´s examination diagnose is suspected when there are typical history and findings of a lowered sensation in the first 3 fingers, a soft grip and tingling and weakness in hand when bending the wrist all the way for some time. Diagnosis can be confirmed with an EMG and nerve conduction velocity, which shows it reduced in the carpal tunnel.

Treatment consists of a splint used to hold the wrist in the middle position. This allows the maximum space for the nerve. The splint can be worn at night. If the condition does not improve, minor surgery may be used to broaden the path of the nerve to make it possible to restore the normal conductivity. If necessary, over the counter pain medication may be used to relieve irritation. It is not wise to postpone treating these symptoms. If this is done, it is possible that residual symptoms persist, and there is actually no cure for them.


Ulnar Nerve Compression

The ulnar nerve in the wrist may also be pinched. The symptoms are similar as in carpal tunnel syndrome, but a feeling of pins and needles and the decreased sensation appears in the 4th and 5th finger and soreness in the wrist is on the side of the little finger. This is called Guyon's canal syndrome.

A typical cause is direct pressure on the nerve for example by bicycle handlebars or against the desk while using a computer.

Avoiding pressure and extreme positions of the wrist at work and during leisure is essential for the treatment. Often also anti-inflammatory medication and physical therapy are used. Surgery may be needed in some cases.

Ganglion

So-called ganglia may appear on the knuckle side of the wrist. They are benign tumors filled with gel-like liquid. They can also appear on the palm side of the wrist.

They are usually painless and produce only a minor cosmetic problem in the form a small bulge. In some cases they may cause pain especially if they are in deeper and get squeezed by the joints during movement.

If the ganglion is found to be deeper in the hand, an ultrasound or MRI may be required to confirm the diagnosis. Treatment consists of draining the fluid and giving a cortisone shot. If this does not eliminate the problem or the problem repeats, surgery may be a possibility. Treatment in the olden days consisted of hitting the ganglion swiftly with a heavy book—this dispersed the ganglion and got rid of the problem.



Arthritis of the Wrist and the Hand

The most common hand problems in the elderly are due to arthritis. It can be of two types: inflammatory such as rheumatoid, gouty or psoriatic arthritis and degenerative such as osteoarthritis.

Rheumatoid arthritis is a systemic disease that destroys bones and joints. Osteoarthritis is a wear and tear disorder affecting any individual joint or several joints. When it destroys the even surfaces of the joint, the bone surfaces touch each other and make the joint painful and stiff. Heredity, fractures, repeat injuries, wrist instability or hard work all can play a role in the development of osteoarthritis.

In rheumatoid arthritis lubricating tissue becomes inflamed and swollen and the joint becomes unstable causing cartilage and bone destruction. Rheumatoid arthritis of the hand typically begins with swelling of the knuckles or the metacarpophalangeal joints or in the joints between the first and second finger bones or the proximal interphalangeal joints. It is usually symmetrical affecting f left and right hand at the same time. The swelling is more pronounced than in cases of degenerative arthritis. Wrist joint is often affected.

Symptoms are those of pain and local swelling. Often some restriction of movements and difficulty gripping objects may appear. Later on deformities in the hand due to luxation may result. The diagnosis of inflammatory arthritis is made based on clinical examination, x-rays, and lab tests.

Osteoarthritis of the wrist is not particularly common. Degenerative arthritis usually damages the middle and top joints of the fingers. They may become lumpy and later slightly twisted. Light swelling may take place at the irritation stage. Pain is the worst factor, and it increases especially during exertion.

Arthritis is also found in the metacarpophalangeal joint of the thumb or the joint connecting the thumb to the hand. This is usually the first joint to experience problems of this type. The symptoms are local pain, a cracking sound, and, less common, swelling. The diagnosis of osteoarthritis is easily confirmed by an x-ray or MRI.

Treatment of rheumatoid arthritis bases on many different medicines used to relieve symptoms, or to prevent or to slow down the progression of the condition. Results are better if started as early as possible, before the disease has not done much irreversible damage.

There is no real solution for degenerative arthritis. The treatment mainly consists of anti-inflammatory medication, sometimes taken long-term. Physical therapy in the form of paraffin treatments or underwater ultrasound treatments may be beneficial. A splint may be used to immobilize the wrist for a short time during the inflammation in any form of arthritis. Exercising the hands is extremely valuable for maintaining their functionality. This may sometimes be easily done in warm water. Cortisone injections may be needed for severely inflamed joints.

If these problems are present, it is necessary to use practical equipment that reduces the need for using strength. Jars can be opened with the help of a damp towel and other devices developed for this purpose. Pincers and other tools may be useful, too.

It may be more comfortable to exercise the fingers in warm water. A soft pillow meant for squeezing with the fingers may help in keeping the hand muscles in decent shape.

When other methods do not provide sufficient pain relief or function of the hands decreases to an unacceptable level, surgery is often considered in an attempt to relieve pain and improve function.

The options most frequently used are a fusion and a joint replacement surgery. After the joining the connection is stable and does not move but also should not produce pain anymore. Prosthesis tries also to restore the normal functioning of the replaced joint.


Dupuytren’s Contracture

For unknown reasons, the membrane structure in the hand may start to thicken. This causes the contraction of the fingers starting with the little finger. A difficult stiffness problem of the finger joints may arise in the worst cases.

Surgery is the only help for this problem. This illness may repeat even after surgery.


Embolism

An embolism that is loose in the arterial circulation may immediately block the circulation to the arms. The embolism usually comes from the heart, aorta, or through the hole in the heart chamber’s wall of the heart from the venous circulation.

The symptom in the arm is a rapid intense pain. The arm changes to a lighter color and becomes cold and numb. There is no pulse, the arm feels cold and numb, and the skin may have a marbled effect.

This condition requires emergency circulatory surgery, because limbs can sustain lack of circulation only temporarily. Treatment consists of intravenous procedures, thrombolytic treatment and traditional surgery.

A venous embolism in the upper limbs is extremely rare. The limb may be painful, and there may be swelling and burning. Diagnosis can be confirmed with an ultrasound or contrast venography. If there is a suspicion of a venous embolism, go to the emergency room immediately.

Emergencies

Strong pain in the arm, loss of color and pulse in the arm.
Pain in the arm and swelling in the hand.

See a Doctor

Pain in the forearm in connection with a rasping sound.
Pain in the wrist in connection with radiating or numbness in the hand.
Swelling in the proximal phalanxes of the fingers.
Other pain that cannot be alleviated by home remedies.

Wrist and hand pain, more information:

Hand exercise videos Tv-gym.com.
Wikipedia on repetitive strain injuries.
Tips to prevent strain injuries.
webMD about carpal tunnel syndrome.
The American Academy of Orthopaedic Surgeons ulnar tunnel syndrome of the wrist.
American Academy of Orthopedic Surgeons on ganglion of the wrist.
American Academy of Orthopedic Surgeons on arthritis of the hand.
American Society for Surgery of the Hand about osteoarthritis.
Wikipedia on rheumatoid arthritis.
Mayoclinic.com pages about Dupuytren's contracture.
Wikipedia on arterial embolism.
Mayoclinic.com pages about cold hands.
HealthDesk.com about spasms of the hands or feet.
Mayoclinic.com about Raynaud's disease.

5 comments:

  1. I have fallen on my right wrist and still have pain below the thumb after week. Any sggestions please?

    ReplyDelete
    Replies
    1. I think it might make sense to discuss with your doctor if it would be needed to do x-ray at least if there is pain at night, clear pain when you press the tip of your thumb when the thumb is extended, if there is obvious tenderness locally or clear pain when you move the thumb with help of the other hand.

      A few days course of prescription-free anti-inflammatory drugs may help. If the pain does not begin to settle down, it makes sense to visit the doctor.

      Delete
  2. Basal joint arthritis of the thumb is more commonly in females over the age of 40. The exact cause of unknown, but researchers have postulated that it’s a combination of factors including joint ligament laxity, deformed joints, prior fracture or injury to the thumb, and repetitive load to the joint which is known as Thumb Arthritis. In the normal joint, cartilage covers the ends of bones to allow for smooth glide with movement of the thumb and act as a shock absorber. The thumb basal joint, is a specialized joint that is saddle-shaped, and allows for significant amount of motion for everyday activities involving pinching and grasping. With progressive wear and tear (degenerative arthritis or osteoarthritis), the cartilage becomes thinner and there is direct contact between the bony surfaces (bone-on-bone). In advanced stages, bone spurs, or osteophytes, can form in the joint, causing the thumb metacarpal to slide out of the saddle. Hyperextension instability can also occur in the adjacent joint (metacarpophalangeal joint).

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  4. Our hands are regularly neglected resources, until the point when damage makes a misfortune in our capacity perform ordinary errands. thejammedfinger.com

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