Causes of wrist and hand pain

Dupuytren's contracture. This is characterized by progressive thickening and fibrosis of the palmar fascia. This condition occurs with a family history (autosomal dominant inheritance), alcoholism, taking antiepileptic drugs, Peyronie's disease (fibroplastic induration of the penis), and congenital knotty fingers. The ring fingers and little fingers are most often affected. Dupuytren's contracture is usually bilateral and symmetrical. The plantar fascia may also be affected. With thickening of the fascia, flexion occurs in the metacarpal joints. If the interphalangeal joints are also involved in the pathological process, the function of the hand may be completely impaired. The goal of surgical intervention is to remove the affected palmar fascia and, therefore, prevent progression of the disease. There is a tendency for the disease to relapse after surgery. Severely affected little fingers may be amputated.

Ganglia. These multifocal swellings (a ganglion is a protrusion of the tendon sheath) most often occur around the wrist joint. They communicate with either the joint capsule or the tendon sheath and appear as smooth, spherical swellings containing a viscous, transparent fluid. Patients require treatment because the ganglia cause local compression symptoms (for example, they compress the median or ulnar nerves at the wrist or the lateral patellar nerve at the knee). A strong blow to such a formation can eliminate it (traditionally, they hit it with the family Bible). It can also disappear after its aspiration with a wide-bore needle. Finally, ganglia can be excised surgically, but their recurrence is observed for quite a long time.

De Quervain's syndrome. Pain is felt over the styloid process of the radius, and thickening of the tendons of the abductor pollicis longus and extensor pollicis brevis is also noted there. The pain intensifies with tension in these tendons (for example, when lifting a kettle). Pain can also be caused by forced flexion or abduction of the thumb. The exact cause of the disease is unknown, but it often occurs after increased strain on these muscles (for example, after wringing out laundry). Initial treatment consists of injection of hydrocortisone around these tendons and into the tendon sheaths. If no improvement occurs after treatment with rest and injection of hydrocortisone, then surgical decompression of these tendons is performed by "removing the roof" from their tendon sheaths using a long incision.

Trigger finger. In this case, constriction at the base of the tendon sheath causes narrowing of the underlying tendon. Most often, the ring and middle fingers are affected, as well as the thumb (especially in infants). Full extension of these fingers cannot be achieved with the help of the muscles of the hand, and if you help with the other hand, then at the moment of achieving full extension of these fingers, the patient feels a kind of "click". In the initial period of the disease, an injection of hydrocortisone can be used. During surgical treatment, the narrowed part of the affected tendon sheath of the flexor muscles is expanded.

Volkmann's ischemic contracture. It occurs when the patency of the brachial artery in the elbow area is impaired (for example, after a supracondylar fracture of the humerus). Muscle necrosis (especially of the long flexor of the pollicis and the deep flexor of the fingers) causes contraction of the corresponding muscles and their fibrosis, which leads to flexion deformity in the wrist and elbow joints. Suspicion of this pathology may arise when the injured hand is cyanotic, the pulse in the radial artery is not palpable, and extension of the fingers is painful. In such cases, it is necessary to separate the bone fragments causing constriction of the artery, warm all the limbs, which promotes vasodilation. If the pulse in the radial artery is not restored after 30 minutes, it is necessary to examine the brachial artery.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]