We move our hands thousands of times a day, making them vulnerable to a range of painful conditions, says Dr Mel Wynne-Jones

Hands

Do you ever experience hand pain? We explain the possible causes and solutions

The 27 little bones in our hands and wrists, anda network of muscles, ligaments and nerves, make our hands incredibly flexible, strong and precise.

But repetitive and/or inappropriate use can cause damage.

It’s easy to strain or sprain fingers, hands or wrists by pulling, pushing or twisting awkwardly or too forcefully, or during a fall.

You’ll notice pain and perhaps some swelling.

You can try treating this yourself with rest, ice wrapped in a tea towel for 15 minutes (applied immediately and four times daily), painkillers and a support bandage if necessary.

But if part of your hand seems displaced, isn’t working properly, or pain/tenderness are severe or don’t ease quickly, seek medical advice.

Many infections can cause pain and swelling in small hand joints, including rubella (German measles), and some bowel or sexually transmitted infections (reactive arthritis).

You’ll feel generally unwell, and may need tests and treatment as for inflammatory arthritis if it doesn’t settle. A single hot, red, swollen joint needs urgent attention.

Localised problems

Tendinitis (inflammation where muscle attaches to bone) can develop for no reason, or be triggered by over- or awkward use of your hands.

It commonly affects tendons that straighten the thumb (De Quervain’s tenosynovitis) or finger (often the ring finger).

You may notice pain, slight swelling, clicking or crackling or find you can’t straighten
it.

Treat as for a strain and take a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen (check with the pharmacist first if you have other medical problems or take other medication).

If this don’t work, a steroid injection into the tendon can relieve pain and get it working.

Ganglions are jelly-filled lumps near the wrist; show your doctor. If they are very large or painful they can be drained or removed under local anaesthetic.

Carpal tunnel syndrome is caused by a trapped nerve at the wrist. It produces numbness and sometimes weakness in the thumb/forefinger, and can be relieved with a small operation (also using local anaesthetic).

Osteoarthritis (OA)

This often starts in late middle age, especially in women and in some families. It can affect the base of the thumb and various finger joints, causing pain and swelling.

You may develop lumps around the end/middle joints – these are also linked to knee OA.

You may need to take a painkiller, eg, paracetamol, but rub-in NSAID or capsaicin (pepper) creams can help too.

If your thumb or finger  becomes very painful or difficult to use, you may be offered a steroid injection or joint replacement.

Inflammatory arthritis

This is more damaging and often affects the knuckles or nearest finger joints, causing severe pain, swelling, heat, redness and stiffness.

It can be caused by rheumatoid arthritis, gout, psoriasis and other diseases that cause inflammation, such as lupus.

These may also affect your eyes, skin and other joints or organs. Prompt anti-inflammatory treatment – NSAIDs, steroid injections, gold injections, powerful disease-modifying anti-rheumatic drugs (DMARDS) such as methotrexate or ‘biologicals’ such as infliximab – can reduce joint damage.

Gout may be controlled with allopurinol tablets. This requires careful monitoring. You may also need physiotherapy, aids for activity or joint replacement.

5 tests you make need

1 Blood tests for inflammation, gout, rheumatoid factor, lupus anticoagulant and/or infection.

2 X-rays for suspected fractures or inflammatory arthritis (not usually needed for OA).

3 Joint aspiration – small needle removes joint fluid to test for infection or crystals (gout).

4 Ultrasound scan – to identify tendon inflammation, ganglion and carpal tunnel syndrome.

5 Blood tests to monitor your bone marrow, liver and/or kidneys if taking powerful drugs.