Prepared by Dr. C. Manamohan
Consultant Orthopaedic & Trauma Surgery and Hand & Microsurgery
Gleneagles Medini Hospital
Pain in the hand, fingers or wrist used to be a relatively uncommon condition. Instead, workers who use their hands extensively to do manual work and heavy lifting are more likely to complain of aching shoulder muscles, a sore back and tired feet at the end of a day’s work!
Unfortunately, pain in the hands and wrist are now more common than ever, thanks to the prevalence of smartphones, digital tablets and computer focused work environments. The constant and prolonged use of these devices can result in strains and inflammation of the tendons, ligaments and nerves around the wrist and hand.
De Quervain’s tendinitis and Trigger Finger (Stenosing Tenosynovitis) are common painful conditions that affect the tendons of the hand. Both these conditions arise from inflammation, swelling and thickening of a tendon within its tendon sheath
De Quervain’s Tendinitis is marked by pain along the thumb side of the wrist and is often associated with a mild but tender swelling. Commonly called Mummy’s thumb, it is sometimes seen in new mothers who repeatedly lift their babies and after breastfeeding. Mothers with De Quervain’s experience severe pain along the base of the thumb when grasping objects, making a fist or while doing twisting and wringing motions of the wrist joint.
Trigger Finger commonly affects the middle and ring fingers. The thumbs and index fingers are also occasionally affected. It may present as pain in the palm or base of the fingers and thumb, with reduced finger range of motion. In more severe cases, the involved digit may “lock-up” or get stuck in a bent position. When this happens, it will be no longer possible to straighten the finger. Force maybe required to release the locked digit, resulting in a clicking sound, accompanied by pain. Trigger Finger is more common in people with diabetes mellitus. Diabetic patients may also develop triggering in multiple digits involving both hands.
Carpal Tunnel Syndrome is probably the most common painful condition of the hand. Worldwide estimates vary, but CTS may affect 3-20 percent of all working age adults, especially those involved in the manufacturing and construction industries. It is also more common in women. Typically, CTS starts as a sudden onset pain around the wrist joint, with numbness and tingling in the thumb, index and middle fingers. Symptoms are usually worse at night. If left untreated, CTS will result in hand muscle wasting and loss of grip strength. CTS can be diagnosed clinically by a doctor, although ultrasound and MRI scans may occasionally be helpful. Electrodiagnostic studies such as Nerve Conduction Studies and Electromyography are often used in Hand Surgery centres to aid in the diagnosis of CTS.
Early stages of CTS, De Quervain’s and Trigger Finger are treated with anti-inflammatory medications, along with resting and splinting of the involved digits and joints. The services of a Hand Therapist or Physiotherapist is often very helpful at this stage and may involve stretching and strengthening exercises. Corticosteroid injections are also often used and provide excellent pain relief to inflamed tendons but are controversial when used in the treatment of CTS.
Surgery is often the only respite for more advanced conditions of the above diseases. Fortunately, whilst technically demanding, these surgeries involve small incisions which can be done under local anaesthesia in a “Day Care” surgery setting that does not require overnight hospital stay. Surgery usually results in excellent outcomes with full return to hand function within 2 weeks.
So, don’t ignore the pain in your hand and please see your doctor if the pain persists. Lastly, practice good work ergonomics and put that smartphone away!