Painful Hand and Wrist Problems
Painful hand and wrist problems
Trigger finger / thumb
Trigger finger , or Stenosing Tenosynovitis, is an acquired condition where the flexor tendon catches on the proximal flexor sheath in the palm producing pain, snapping (or “triggering”) or locking (in flexion or extension) of the affected finger/thumb. This is commonly worse first thing in the morning and more often seen in diabetic patients. About a third of patients will settle without the need for any intervention but most of the rest will settle down with a simple steroid injection around the tendon in the palm – this is done under local anaesthetic control. Very rarely it will be necessary to suggest a simple day-case local anaesthetic release of the pulley in the palm.
De Quervain’s Tenosynovitis
This painful condition affects the inside of your wrist (thumb side) on certain movements – it commonly occurs after an episode of overuse in young women and leads to local swelling and pain. Young sports people and mothers with their first baby are commonly seen. Again the cause would appear to be a discrepancy between the size of the tendons moving the thumb and the little tunnel they pass through at the wrist. Hand physiotherapy with ultrasound and splinting often helps but a simple local steroid injection provides relief in the vast majority of cases. Again very rarely it will be necessary to suggest a simple day-case local anaesthetic release of the constriction.
This little benign tumour is in fact very rare but so distinctive and difficult to diagnose that people may have lived with them for years. They commonly occur under the nail-bed and are difficult to see; perhaps a bluish/red blush is all that is apparent. They are terribly painful however with spasmodic shooting pain, cold intolerance and a noticeably tender single spot. Once diagnosed they are relatively simple to remove with a simple day-case local anaesthetic removal of the tiny lump.
Chronic Regional Pain Syndrome
About 5% of patients may present with a troubling, inappropriately painful hand after either a relatively trivial hand injury or after any hand surgery or intervention. This is potentially devastating for the patient and their hand and presents typically with pain, swelling, colour changes, sweating and poor movement. For some reason the autonomic nervous system (supplying all parts of the body and controlling your automatic or autonomic responses to e.g. temperature, pain) becomes over-active. In the early stages and when promptly recognised treatment can be effective and involves intensive hand physiotherapy, appropriate pain-killers (often under the guidance of a pain anaesthetist) and specific targeted drugs acting on the sympathetic autonomic nervous system. If left late or with poor response to treatment the hand can be left in a very poor condition.
Any other persistent, painful hand condition should be seen by your GP and/or experienced Hand Surgeon.