Take good care of your hands
Pain in the hands is a common complaint. Numerous structures within your hands could give rise to symptoms. Joint disease, nerve related issues and blood vessel problems are some of the key causes of hand ache. The human hand is a remarkable tool that helped us in leaps and bounds during many evolutionary steps. Your hand is capable of strength related movements such as heaving the entire body’s weight. It can also perform extremely clever fine movements like knitting and typing. It is the complex nature of the finger mobility that later becomes a disadvantage and leads to hand pain.
Osteoarthritis
What joint conditions cause hand pain?
Osteoarthritis, earlier termed wear and tear arthritis, is one of the commonest causes of hand pain. The base of the thumb is a key area to get affected by osteoarthritis. Even the joints of the fingers can swell up in this condition, appearing as bony nodules. Stiffness is felt after periods of rest and lasts for a few minutes. Sometimes patients with osteoarthritis complain of similar symptoms over the knees. Most of the patients I encounter are troubled about the slight disfigurement seen over the fingers. Osteoarthritis is known to cause deformities, but these are considered harmless and usually do not cause severe disability.
In rheumatoid arthritis, hand pain could be the first thing you encounter in the morning with stiffness of the joints. This might last an hour or more before subsiding. The joints “swell softly” and are compressible unlike osteoarthritis. Rheumatoid arthritis is seen in the young and the middle aged, and is common among females. If not diagnosed early, this ailment could lead to deformities of the fingers. Rheumatoid arthritis can involve other joints like the wrists, elbows and knees. Within large joints it could lead to a fluid collection. When joints swell up with pain on touch, warmth and overlying skin redness, the term inflammatory arthritis is used. Rheumatoid arthritis is the commonest type of inflammatory arthritis worldwide.
Other than these, there are conditions where a single or a few joints cause very severe pain. Dactylitis or a sausage finger is when the entire finger gets swollen. The appearance mimics a sausage. Dactylitis is related to a skin condition called psoriasis and arthritis. Wrist swelling close to the base of thumb is termed De Quervain’s Tenosynovitis. Here a structure called a tendon is the root cause of pain.
Rheumatoid arthritis
When fingers snap between two different positions we call it a trigger finger. Like a trigger of a gun the affected finger is either kept in the bent or straightened position. Any attempt to move the finger causes a painful snap. There are numerous reasons for trigger fingers. Spontaneous swelling of the hand tendons is the leading cause. Treatment is directed at settling the tendon swelling.
A disease named Raynaud’s phenomenon can cause a painful colour change at the tip of the fingers (and toes) which happens when the body is exposed to cold weather. The patients note white fingers which might change over to a bluish tinge and then red colour over time. Raynaud’s phenomenon could sometimes mean that you are having an underlying type of arthritis.
Certain occupations inevitably cause repetitive injury to some of fingers. Especially in jobs where heavy tools are handled such as carpentry, stone masonry these finger injuries are obvious. Patients who have long term hand arthritis avoid using fingers. The muscles undergo a change named disuse atrophy where they thin out. Hence treatment of hand arthritis involves encouraging patients to perform gentle exercises.
Treatment of joint conditions involves diagnosing the correct disease through a good examination of the hand and settling the underlying reason for pain. Blood tests and x-rays of the hand are valuable investigations that the doctor might order before coming to a conclusion.
Nerve related causes for hand pain
As mentioned earlier the delicate nerves supplying senses to the hand can get trapped at various sites. The commonest of such “entrapment neuropathies” is named carpal tunnel syndrome. Here a nerve which runs beneath your wrist is pinched by a collapsing tunnel. Pain is felt over the thumb, index and middle fingers. Sometimes it could spread to the forearm. Carpal tunnel syndrome requires a small surgery after the correct diagnosis.
If the patient is suffering from diseases such as diabetes, all nerves in general can get affected. When this happens in the hands, it could cause a stocking type of sensory disturbance. The patient may complain that a painful numbness is felt as if he is wearing a stocking. We term these as peripheral neuropathies. There are numerous diseases that cause peripheral neuropathies other than diabetes. Investigations could involve a test called nerve conduction study. The tiny amounts of electricity transmitted over the nerves is measured using a special machine. The speed and the amount of current travelling through the nerves gives us an indirect measurement of how bad the condition is.
(The writer is a Consultant in Joint Disease, Rheumatology and Rehabilitation)
| The correct diagnosis A vital step in curing hand pain is making the correct diagnosis. Even if your symptoms mimic someone else’s, the underlying disease might be an entirely different one. Most causes of hand pain can be cured with specialised care. Take good care of your hands, as most of the daily tasks are entirely dependent on how well your fingers function. | |