Hand & Wrist Pain and Arthritis

Of innumerable causes of pain in the hand, a few are presented here.

• Injury

• Carpal Bossing

• Arthritis

• Avascular Necrosis of Lunate (Kienbock's disease)

• Occult Ganglion

• Ulnar-Sided Wrist Pain

• Fracture of Hook of the Hamate Bone

• Glomus Tumour

• de Quervain's Disease

• First Carpometacarpal Joint Arthritis

• Scaphoid Trapezium Trapezoid Arthritis

• Scaphoid Non-Union Advanced Collapse

• Scapholunate Dissociation

• Ulnar Impaction Syndrome

• Intersection Syndrome

Broadly speaking, pain may be due to:

• Injury: acute or in the past
• Degeneration
• Infection
• Tumour
• Disease

The location will help clinch the diagnosis, and the diagnosis will dictate the treatment.

Injury to a part of the body precipitates pain.

Injury to the collateral ligament produces pain on the side of the joint.

Volar plate injury causes pain on the palmar side of the finger.

Dorsal injury to the joint usually follows cartilage damage.

Fracture and its subsequent effects in the form of abnormal union or malunion or failure to unite can lead to abnormal alteration in bony alignment, can alter the kinetic chain of alignment, and can cause pain.

So, if a patient has persistent pain or pain returning after a previous injury in the remote past, it requires examination and assessment to find out the reason for the pain. Pain killers and similar medications on a long-term basis without evaluation may be harmful.

Location of pain, duration of pain, and past history of an injury will help clinch the diagnosis.

It is the premature degeneration of metacarpal bone/s at the base of the 2nd and 3rd metacarpals. There is a hard and painful bump at the base of these metacarpals.

Routine plain X-rays may not reveal the abnormality. A special position of the wrist is needed. The wrist is acutely flexed, and its ulnar border rests on the X-ray cassette. The most painful part of the wrist thus forms the silhouette to take an X-ray picture.

Initial treatment consists of rest, ice application at the painful area, a cockup splint, and medicines to alleviate the pain. If these measures fail to ease the pain, surgical excision of the bony bump will help alleviate the pain.

One or more joints may be damaged following injury or a disease. Initial pain may be off and on and affects the activities minimally, but with time, it becomes continuous and restricts activities.

Injury and diseases like Collagen disorders, Rheumatoid Arthritis, and Psoriatic arthritis can cause joint damage or arthritis.

Initial X-rays may be normal with the passage of time, the changes in the X-ray become obvious, suggesting arthritis.

Initial treatment consists of local ice application, rest, and support called a splint. Some patients benefit from the application of heat or the alternate application of heat and cold. Persistent pain bothering the patient and not responding to non-operative methods warrants surgical intervention of the affected joint.

Generally speaking, the surgery may be either removal of the affected joint(Excision) or fusion(Arthrodesis), or replacement of the damaged joint(Arthroplasty) with either an artificial joint or part of the body itself.

Kienböck's disease is a condition in which the lunate, a small but critical bone at the center of the wrist, loses its blood supply (a condition known as avascular necrosis). While the exact cause remains unclear, this loss of circulation leads to the gradual collapse of the lunate and disrupts the alignment and movement of surrounding wrist bones.

Most patients deny previous trauma or a very trivial trauma in the past.

Early Symptoms

• In the early stages, patients may experience:
• Central wrist pain (especially during movement).
• Stiffness or reduced range of motion.
• No visible changes on X-rays.

An MRI scan is often needed to detect the disease in its early phase, as it can reveal changes in the bone structure and vascularity before they appear on standard X-rays.

Why Early Detection Matters?

As Kienböck's disease progresses, it can lead to increasing pain in the wrist, joint instability, arthritis, and permanent loss of wrist function. Early diagnosis allows for better management and treatment options, potentially preventing long-term disability.

In many cases, surgery is required to manage Kienböck's disease and prevent further damage. The choice of procedure depends on the stage of the disease, patient age, and wrist mechanics.

Common surgical options include:

*Radial shortening osteotomy, to reduce pressure on the lunate and improve blood flow.

*Capitate shortening, to reduce load on the lunate in those patients who have a longer ulna.

*Core decompression of the radius, to relieve internal bone pressure and promote revascularization.

*Proximal row carpectomy, a salvage procedure in advanced stages where the lunate and nearby bones are removed to relieve pain and preserve motion

Early diagnosis followed by the appropriate surgical intervention can significantly improve outcomes and preserve wrist function.

An occult ganglion is a small, hidden fluid fluid-filled cyst that forms near the wrist joint but is not visible or palpable on physical examination, hence the term "occult," meaning hidden. Despite its small size, it can cause significant wrist pain, especially with movement or when pressure is applied.

Symptoms:

• Vague or localized wrist pain (often over the dorsal or volar side).
• Tenderness without any visible swelling.
• Pain aggravated by activity or wrist extension.
• Diagnosis:

Occult ganglions are not seen on X-rays. An MRI or high-resolution ultrasound is usually needed to detect these hidden cysts and confirm the diagnosis.

Treatment:

Initial treatment includes:

• Wrist splinting
• Anti-inflammatory medications
• Activity modification

If symptoms persist, surgical excision of the ganglion may be necessary. This usually provides lasting relief and restores wrist function.

Early diagnosis helps avoid unnecessary loss of work hours and improves outcomes.

Pain on the ulnar side of the wrist, the side closer to the little finger, is a common but often puzzling complaint.

Unlike thumb-side (radial) wrist issues, ulnar-sided pain can arise from a range of conditions such as TFCC (Triangular Fibrocartilage Complex) injuries, Ulnar Impaction Syndrome, hook of hamate fractures, ECU (Extensor Carpi Ulnaris) tendon instability, or even arthritis.

Patients may report pain during gripping, twisting actions like opening a jar, or lifting weight. Clicking or catching sensations may also be present.

Because of the complex anatomy and overlapping symptoms, a careful clinical evaluation and targeted imaging (like MRI or CT scan) are often needed to determine the exact cause.

Accurate diagnosis is the key to successful treatment. Initial management may involve rest, splinting, physiotherapy, and anti-inflammatory medications.

In cases where symptoms persist, surgery might be recommended.

Left untreated, chronic ulnar-sided wrist pain can significantly impact hand function, especially for athletes, manual workers, and those involved in repetitive hand use. A personalized treatment plan helps not just in relieving pain but also in restoring full function and confidence in hand use

Ulnar impaction syndrome (also called ulnar abutment syndrome) is a condition where the ulna (the outer forearm bone) is slightly longer than the radius, causing it to press against the small bones of the wrist, especially the l_unate_ and triangular fibrocartilage complex (TFCC). This repeated contact leads to pain, cartilage wear, and degeneration.

Causes:

• Congenital (naturally longer ulna).
• After a fracture or shortening of the radius.
• Repetitive wrist loading (common in athletes, gym-goers).

Symptoms :

• Pain on the ulnar (little finger) side of the wrist.
• Worsens with gripping, rotation, or weight-bearing.
• Clicking or catching sensations.
• Decreased wrist strength.

Diagnosis:

X-rays, MRI, or wrist loading tests help confirm the condition and assess ulnar variance.

Treatment:

• Activity modification and rest.
• Wrist splinting.
• Anti-inflammatory medications.
• Steroid injections (for temporary relief).
• Surgical options like ulnar shortening osteotomy or wafer procedure in persistent or severe cases

Early diagnosis and treatment can prevent permanent joint damage and restore wrist function.

The hook of hamate is a small, hook-like projection on the palm-side of one of the carpal (wrist) bones, located near the base of the ring and little fingers. Though small in size, it serves as an anchor point for ligaments and tendons and forms part of the tunnel through which the ulnar nerve and artery pass into the hand. A fracture of the hook of hamate is a relatively rare but significant injury, particularly seen in sports involving equipment, such as tennis, golf, cricket, and baseball, where the butt of a racquet, bat, or club repeatedly strikes or presses against the palm.

is a benign growth under the nail that produces very severe pain. Patients seek help quite late at times, after several years or decades, as the initial diagnosis is missed.

At times, a visible bluish spot under the nail.

MRI with contrast will clinch the diagnosis . It is important to seek a dedicated x ray of the affected part of the finger and not an MRI of the hand for appropriate magnification.

De Quervain's disease is a painful condition that affects the tendons on the thumb side of your wrist. It is commonly seen in individuals who perform repetitive hand or wrist movements, such as lifting a baby, texting frequently, knitting, gardening, or doing household chores. It may occur during pregnancy.

The condition involves inflammation and thickening of the two tendons that control the movement of the thumb, the abductor pollicis longus and extensor pollicis brevis, as they pass through a narrow sheath at the wrist. This inflammation makes tendon movement painful and restricted, especially during gripping or lifting actions.

Common Symptoms:

• Pain and swelling near the base of the thumb, often radiating toward the forearm.
• Difficulty holding or pinching objects.
• Worsening pain with wrist or thumb motion
• A catching, snapping, or "sticking" feeling in the thumb
• Tenderness over the thumb-side of the wrist.

(A related tendon-catching problem is trigger finger.)

Who is at Risk?

• New mothers (sometimes called "Mommy's thumb").
• Repetitive manual workers (e.g., typists, cooks, tailors).
• Athletes and gym users.
• Anyone with repeated wrist strain or trauma.

Diagnosis

A clinical examination including the Finkelstein test helps confirm the diagnosis. In this test, the patient bends the thumb into the palm, wraps the fingers over it, and then tilts the wrist towards the little finger. Sharp pain during this maneuver strongly suggests De Quervain's disease.

Treatment Options

• Rest and activity modification: Avoiding aggravating movements is the first step.
• Thumb spica splinting: A special splint that immobilizes the wrist and thumb can provide significant relief.
• Anti-inflammatory medications: These help reduce pain and swelling.
• Steroid injection: A local corticosteroid injection into the tendon sheath is often highly effective and may resolve symptoms completely.A single low dose steroid is safe.
• Surgery: In chronic or non-responsive cases, a minor surgical procedure may be performed to release the tight sheath and relieve pressure on the tendons.

Most patients recover well with timely and appropriate treatment. If you're experiencing persistent pain on the thumb side of your wrist, don't ignore it, early intervention can prevent long-term discomfort.

STT arthritis is a form of localised wrist arthritis that affects the joints between three small bones on the thumb side of the wrist: the scaphoid, trapezium, and trapezoid bones. These joints are crucial for thumb and wrist stability and motion, especially during gripping and pinching activities.

What Causes It?

STT arthritis is typically due to wear and tear (osteoarthritis) over time. It may also develop after an injury, repetitive stress, or in association with other wrist conditions like scapholunate ligament injury.

Symptoms:

• Deep aching pain on the thumb side of the wrist.
• Pain worsens with pinching, gripping, or lifting.
• Stiffness or reduced wrist motion.
• Occasional swelling or tenderness over the STT joint.
• Diagnosis:

A combination of physical examination and imaging (X-rays) helps confirm the diagnosis and assess the severity.

Treatment Options:

• Rest and activity modification
• Wrist splint or thumb spica brace.
• Anti-inflammatory medications
• Steroid injection into the joint for temporary relief.

In advanced cases, surgical options such as joint fusion or may be considered.

Early treatment can relieve symptoms and delay progression. If you're experiencing pain at the base of the thumb that does not improve with rest, a consultation with a hand specialist is recommended.Early treatment can relieve symptoms and delay progression. If you're experiencing pain at the base of the thumb that does not improve with rest, a consultation with a hand specialist is recommended.

The first carpometacarpal (CMC) joint is the joint at the base of the thumb, where the first metacarpal bone meets the trapezium bone of the wrist. This joint allows a wide range of thumb movements, including pinching, gripping, and rotating, making it essential for most hand functions.

Because of its high mobility and frequent use, the first CMC joint is prone to wear and tear, especially with age. This can lead to a common condition known as CMC joint arthritis, or basal joint arthritis.

Common Issues Involving the First CMC Joint:

• Instability or laxity of the joint, especially in younger individuals or postpartum women
• Osteoarthritis due to cartilage degeneration, more common in women over 40
• Pain and swelling at the base of the thumb
• Weak grip or difficulty with activities like opening jars, turning keys, or writing

Diagnosis:

A clinical examination often reveals tenderness, swelling, or a grinding sensation at the joint. X-rays can confirm arthritis or joint changes.

Treatment Options:

• Activity modification and ergonomic support.
• Thumb splints or braces to stabilize the joint.
• Anti-inflammatory medications.
• Steroid injections for temporary relief.

In persistent or advanced cases, surgical options such as ligament reconstruction, joint resurfacing, or trapeziectomy may be considered.

Maintaining thumb function and relieving pain is the key goal of treatment. If you notice persistent pain or weakness at the base of your thumb, early evaluation can help prevent worsening and preserve hand strength.

SNAC wrist is a progressive condition of the wrist that develops after an untreated or improperly healed scaphoid fracture. The scaphoid is one of the small carpal bones in the wrist, and if it doesn't heal properly, it can lead to a nonunion, a persistent gap between the broken bone fragments. Over time, this leads to abnormal wrist mechanics and gradual collapse of the wrist bones, resulting in arthritis and pain.

What Causes SNAC Wrist?

• Neglected or missed scaphoid fracture.
• Failed previous treatment.
• Chronic instability and abnormal movement in the wrist due to the unhealed scaphoid.

Stages of SNAC Wrist:

Stage I, Arthritis between the radial styloid and distal scaphoid.

Stage II, Arthritis extends between the scaphoid and capitate

Stage III, Midcarpal arthritis between capitate and lunate

Symptoms::

• Deep, aching wrist pain.
• Reduced grip strength.
• Stiffness and limited motion.
• Swelling and tenderness.
• Pain that worsens with activity.

Diagnosis::

A good quality X-rays and at times CT scans help confirm scaphoid nonunion and assess the pattern of arthritis.

Treatment Options:

• Early stage: Wrist splinting, NSAIDs, and activity modification.
• Intermediate stage: Bone grafting or limited wrist fusion.
• Advanced stage: Surgical procedures such as:
• Proximal row carpectomy (PRC)
• Four-corner fusion
• Wrist fusion (in severe cases).

Timely intervention can relieve pain and preserve as much wrist function as possible. If you have a history of wrist injury and are experiencing chronic pain, it's important to get evaluated for conditions like SNAC wrist before arthritis progress.

Scapholunate dissociation is a common cause of wrist instability. It occurs when the ligament connecting the scaphoid and lunate bones in the wrist is stretched or torn, usually due to a fall on an outstretched hand.

Key Features:

• Pain in the center or back of the wrist.
• Clicking, swelling, or weakness during grip.
• May lead to SLAC wrist arthritis if untreated.
• Diagnosis is confirmed with clinical tests and X-rays.

Treatment:

• Mild cases: Splinting and physiotherapy.
• Complete tears: May require ligament repair or reconstruction surgery.
• One option is to insert staples to retain the bones together.

Ideally, early treatment will prevent arthritis from setting in.

Early diagnosis is important to prevent long-term damage.

Intersection syndrome is a relatively uncommon but painful inflammatory condition of the distal forearm and wrist caused by repetitive friction between two sets of tendons. It typically affects individuals involved in sports or occupations that require forceful and repeated wrist extension, such as rowers, weightlifters, skiers, motorcyclists, and factory workers.

The condition occurs where the first dorsal compartment tendons (abductor pollicis longus and extensor pollicis brevis) cross over the second compartment tendons (extensor carpi radialis longus and brevis), usually 4-6 cm proximal to the wrist joint.

Symptoms include localized pain, swelling, tenderness, and a distinct creaking or squeaking sound (crepitus) with wrist movement. The pain often worsens with activity and may radiate along the forearm.

It can sometimes be mistaken for De Quervain's tenosynovitis, but the tenderness in intersection syndrome is located slightly more proximally.

Early diagnosis and conservative treatment are crucial. This includes activity modification, rest, wrist splinting, ice application, NSAIDs, and physiotherapy. In persistent or severe cases, corticosteroid injections may help reduce inflammation. Surgery is rarely needed but may be considered for chronic, treatment-resistant cases. With timely intervention, most patients recover well and return to their usual activities.