Wrist and hand pain
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| Wrist and hand pain Classification and external resources |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Phone:617-525-7431
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Overview
The wrist contains eight carpal bones. These bones are aligned by a sequence of ligaments and cartilaginous connective tissue. Though pain and numbness is a frequent presentation, carpal tunnel syndrome is the most common diagnosis.
Diagnosis
Physical Examination
Extremities
- Tinel's sign
- Positive when pain occurs if anterior wrist is tapped.
- Phalen's sign
- Positive if flexing the wrist for more than 30 seconds causes pain or numbness
Laboratory Findings
- Typically unnecessary though some tests may include:
X Ray
- PA
- Lateral
- Oblique
MRI and CT
- Rarely used
- May be needed to diagnose masses causing nerve problems or compromise of the vascular system
Other Imaging Findings
- Bone scan may be needed to asess potential avascular necrosis, occult fracture or infections of the bone.
Other Diagnostic Studies
- If carpal tunnel syndrome or other neuropathy is suspected, EMG and nerve conduction studies should be performed.
- If warmth and redness are present in wrist and MCP joints, Arthrocentisis with crystal analysis may be necessary
Differential Diagnosis of Causes of Wrist and hand pain
- Most frequent cause of wrist discomfort and morbidity
- Linked to repetative activities
- For example: writing, typing, etc.
- Symptoms are a consequence of the mendian nerve becoming trapped beneath the transverse ligament cause pain and numbness.
- Injury due to overuse
- Osteoarthritis
- Tenosynovitis or DeQuervain's of the radial wrist
- Caused by the inflammation in the tendon sheaths of the extensor pollicis brevis and abductor pollis longus
- Ganglion cysts
- Growths common to the wrist area taking place on the dorsal and ventral surfaces.
- These cysts are round, tender to touch and movable.
- Trauma
- Falling on the wrist is the most common method of injury
- The scaphoid bone is the most commonly injured
- Other means of trauma include:
- direct hit
- crush
- fall when wrist is in a vulnerable position
- twisted wrist
- Fibromyalgia
- Keinböck's Disease
- Compartment Syndrome
- Compression of the lymphatic system or venous system due to chest or shoulder masses
- Venous thrombosis in subclavian veins and distal veins
- Paralysis (flaccid) after CVA
- Quinke's disease resultant of hymenoptera sting
- Rhumatologic disease
- Insect sting/bite
- Infections
Treatment
- Corticosteroid injection makes progress in more than half of patients
- Corticosteroid injection alongside the tendon sheaths
Acute Pharmacotherapies
- NSAIDs reduce inflammation
- Stings
Surgery and Device Based Therapy
Indications for Surgery
- require a minimally invasive prcedure that includes draining fluid from the cyst and injecting a steroid.
- Surgery to remove Ganglion cysts is occasionally required
- Surgery is potentially needed to remove the pressure from the nerve area and remove the transverse ligament from beneath the median nerve
Device Based Therapy
- cock-up splints relieve pressure and strain during repetative activities
- Thumb spica splint
- Casting and X-ray in 7-9 days in order to avert complications of occult fractures
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
