Main reasons
The most common group is overload tendon injuries. De Quervain's tendinitis is characterized by pain at the base of the big toe during abduction and grip, typical for young mothers and people who type a lot on the phone. The trigger finger produces a painful click when extended. The second group is compression of nerves: carpal tunnel syndrome with the median nerve, less often compression of the ulnar nerve. The third is joint diseases: arthrosis of the base of the thumb in people over 50 years old, rheumatoid arthritis with symmetrical damage to small joints, gout. Separately, there are injuries, cysts and consequences of fractures.
- De Quervain's tendinitis
- snapping finger
- Carpal tunnel syndrome
- Arthrosis of the carpometacarpal joint of the thumb
- Rheumatoid arthritis
- Gout
- Hygroma (ganglion cyst)
- Injuries and consequences of fractures
How to understand that it is carpal tunnel syndrome
Carpal tunnel syndrome occurs when the median nerve becomes compressed under a tight ligament on the palm side of the wrist. A characteristic feature is night and morning numbness and tingling in the thumb, index, middle and half of the ring finger; the person wakes up and shakes his hand to restore sensitivity. During the day, symptoms intensify when holding the phone, steering wheel, or reading a book. Over time, grip weakness appears, objects fall out of the hands, and in advanced cases, the muscles at the base of the thumb decrease. The risk is higher during pregnancy, diabetes, hypothyroidism and monotonous manual work.
- Numbness and tingling at night and in the morning
- Involvement of the thumb, index and middle fingers
- Desire to shake the brush for relief
- Strengthening when holding the phone and steering wheel
- Weak grip and items falling out
- Weight loss of muscles at the base of the big toe
When it's about trauma
After falling on an outstretched arm, the pain in the wrist can easily be attributed to a bruise, but this is exactly how the most insidious fracture occurs - the scaphoid bone. In the first pictures it is often not visible, and without proper treatment the bone heals poorly, and persistent pain develops with impaired function. Therefore, if there is pain in the area of the anatomical snuffbox, a repeat image or computed tomography is required. Sprains, damage to the triangular cartilaginous complex and fractures of the radius in a typical location also cause pain and swelling. Any deformation, inability to move the hand and increasing swelling require urgent treatment.
- Falling on an outstretched arm
- A scaphoid fracture may not be immediately visible
- Fracture of the radius in a typical location
- Damage to ligaments and cartilage complex
- Deformation and increasing swelling - see a doctor immediately
- Repeat X-ray or CT scan if pain persists
Survey
An examination with functional tests often suggests a diagnosis already at the appointment: the doctor checks painful points, range of motion, grip strength and special tests for nerve compression and tendon inflammation. X-rays are needed in case of injury, suspected arthrosis and deformity. Ultrasound clearly shows tendons, their sheaths, cysts and allows you to evaluate the nerve in the canal. MRI is used when the picture is unclear, when there is suspicion of ligament and cartilage damage, as well as when there is an occult fracture. Electroneuromyography confirms and evaluates the degree of nerve compression. If inflammatory joint diseases are suspected, laboratory tests are prescribed.
- Inspection with functional tests
- X-ray of hand and wrist
- Ultrasound of the wrist joint and tendons
- MRI of the hand with an unclear picture
- ENMG for numbness and weakness
- Uric acid and rheumatological tests as indicated
Treatment and prevention
In overload conditions, the basis is temporary unloading and changing the load: an orthosis, especially at night with carpal tunnel syndrome, pauses in work, proper organization of the workplace with forearm support. Therapeutic gymnastics and stretching and strengthening exercises selected by a specialist, as well as local anti-inflammatory drugs, help. If the pain is severe, the doctor may inject a glucocorticoid into the tendon canal area. Surgery is considered for persistent symptoms, muscle weakness and wasting, and for trigger finger that does not respond to conservative measures. For systemic diseases, treatment is carried out by a rheumatologist.
- Wrist brace, especially at night
- Pauses and changing hand positions when working
- Workplace ergonomics and forearm support
- Therapeutic gymnastics and exercises
- Local anti-inflammatory drugs
- Glucocorticoid injection as prescribed by a doctor
- Surgery for persistent symptoms and weakness