Troubleshooting Hand Pain
Pain, stiffness, deformity and numbness in your hands can make even the simplest tasks challenging.
Your incredible intricate hands allow you to do amazing things, from mundane jobs, such as opening jars or typing, to more refined tasks, such as woodworking or playing the piano. You may take your hands for granted, until something goes wrong. Hand pain, stiffness and deformities can occur for a variety of reasons and can complicate your life.
“Certain distinguishing features can help identify most noninjury causes of hand problems,” says Arthritis Advisor Editor-in-Chief and orthopaedic surgeon Steven Maschke, MD.
Osteoarthritis (OA), which occurs when the cushioning material (cartilage) that covers the ends of bones in joints wears down, can affect several joints in the body, including the hands. Women are more likely to have hand OA than men.
“A common location is the joint at the base of the thumb,” says Dr. Maschke. OA in this first carpometacarpal (CMC) joint arises from some loosening of the ligaments that hold the joint stable. “The joint can become swollen from the bone slipping,” says Dr. Maschke. The result is pain with thumb and index finger hinge movements, such as turning a key.
You can also develop OA in the other fingers, mostly in the joint nearest the fingertip (the distal interphalangeal, or DIP, joint), but also the middle joint of the finger (the proximal interphalangeal, or PIP, joint). You can inherit a predisposition to having arthritis in these joints, particularly if your mother or grandmother had osteoarthritis.
“About half of people who have osteoarthritis in the DIP or PIP joints experience pain, and about half complain of stiffness or deformity,” says Dr. Maschke. Deformities include Bouchard’s nodes, which are bone growths on the PIP joint, and Heberden’s nodes, which are bone growths on the DIP joint.
Treatment for thumb OA starts with immobilizing the joint with a rigid splint worn at night and a more flexible one to use during the day. OA in the other fingers doesn’t require a splint, but applying heat can be soothing.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. The topical NSAID diclofenac (Voltaren® Gel) can be effective in hands because the joints are near the skin surface, so the medication easily penetrates. Capsaicin cream, available without a prescription, may also help. Corticosteroid injections can be considered to treat pain, but they may not improve motion.
Surgery is a last resort. For the thumb, the procedure involves removing bone at the base of the thumb and replacing it with a piece of tendon, which provides a cushion. If there is significant deformity at the DIP joint, surgery to fuse the joint is an option. The PIP joint can either be fused or replaced with metal or plastic implants.
Rheumatoid arthritis (RA) has a different cause than OA, but it can also affect joints in the hands. With RA, the body’s immune system attacks the tissue lining the joints, leading to pain, swelling, deformity and stiffness.
In the hands, RA tends to affect the wrists, large knuckles (metacarpophalangeal, or MCP, joint) and, less commonly, the PIP joint. In most cases, both hands will be affected. As RA gets worse, the fingers may start to bend toward the small finger. Some people are prone to developing RA nodules, which are lumps under the skin near the joint.
There is effective treatment for RA. “We’ve learned that the sooner treatment is started the better the results,” says Dr. Maschke. “You can go into remission and prevent the joint destruction that leads to some of the disfigurement.”
Another type of arthritis, psoriatic arthritis, also often affects the hands. It tends to cause joints to fuse, which results in a stiff joint. In addition, the fingers can swell up, giving them a sausage-like appearance (called dactylitis).
Like RA, psoriatic arthritis is an autoimmune disease, and there are effective medications.
Carpal Tunnel Syndrome
If you have numbness and tingling in the thumb, index, middle and ring fingers, you might have carpal tunnel syndrome. “A common complaint is waking up at night with numbness and tingling that makes you want to shake your hand,” says Dr. Maschke.
Although the symptoms are felt in the fingers, the problem originates in the wrist. A main nerve (median nerve) and nine tendons run through a passageway in the wrist (the carpal tunnel) to the hand. Inflammation in this tunnel can compress the nerve, causing the symptoms.
Wearing a brace at night that prevents the wrist from bending often is all that is required to relieve symptoms. A corticosteroid injection and surgery are options if that fails.
A condition called trigger finger can be felt as a stiff, painful finger. “It can also create a clicking and catching of the finger,” says Dr. Maschke. In more severe cases, the finger locks into a flexed position.
Trigger finger occurs because of a mismatch in the size of the tendon that runs out to the finger and the sheath that surrounds it, which prevents the tendon from gliding normally. The ring finger is most commonly affected, but it can occur in all five fingers.
The cause is not known, but inflammation likely plays a role. People with diabetes are at increased risk. Trigger finger is most often treated with a corticosteroid injection. If that doesn’t work, surgery can be done to release the tendon sheath.
Sagittal Band Rupture
Similar to trigger finger, sagittal band rupture causes a clicking sensation and possibly a bent finger. It occurs because extensor tendons on the back of the hand slip to the side. Inflammation, arthritis or an injury can lead to this condition. “Something as simple as flicking something with your finger can cause sagittal band rupture,” says Dr. Maschke.
Initially, it is treated with a splint. Surgical repair or reconstruction may be needed depending on the degree of the deformity.
Another condition that leads to bent fingers is Dupuytren’s contracture. Tissue under the skin in the palm of the hand thickens. It starts as nodules that you can feel. Over time, long cords form, which draw the fingers down into the palm. “It’s like having a rope pulling the finger down and you can’t straighten it,” says Dr. Maschke.
It may be uncomfortable, but it’s not painful. There are three possible treatments. Needle aponeurotomy severs the cord to stretch out the finger. An injection of the drug Xiaflex® breaks down the fibers in the cord. Surgery to remove the cord can be done in more severe cases.