Hand Pain: Common Diseases, Conditions, and When to Seek Medical Attention

What disease makes your hands hurt?

Hand pain is a common and often debilitating symptom that can stem from a variety of underlying medical conditions, ranging from inflammatory and degenerative joint diseases to nerve compression syndromes and systemic disorders.

Understanding Hand Pain: A Kinesiological Perspective

The human hand is an intricate marvel of biomechanics, comprising 27 bones, numerous joints, a complex network of tendons, ligaments, nerves, and blood vessels. Its remarkable dexterity and strength make it indispensable for daily activities. Consequently, when pain arises in the hands, it can significantly impair function and quality of life. As fitness professionals and kinesiologists, understanding the potential causes of hand pain is crucial for guiding clients, recognizing red flags, and ensuring appropriate referrals to medical professionals.

Common Diseases and Conditions Causing Hand Pain

Many conditions can lead to pain in the hands, each with distinct characteristics and mechanisms.

• Osteoarthritis (OA):

  • What it is: A degenerative joint disease characterized by the breakdown of cartilage, the protective tissue that cushions the ends of bones. It's often referred to as "wear-and-tear" arthritis.
  • How it affects the hands: In the hands, OA commonly affects the joints closest to the fingertips (distal interphalangeal, or DIP joints), the middle finger joints (proximal interphalangeal, or PIP joints), and the base of the thumb (carpometacarpal, or CMC joint). The cartilage erosion leads to bone-on-bone friction, inflammation, and the formation of bony spurs (osteophytes).
  • Key symptoms: Deep, aching pain that often worsens with activity and improves with rest. Stiffness, particularly in the morning or after periods of inactivity. Swelling, tenderness, and the development of hard, bony lumps on the finger joints (Heberden's nodes on DIP joints, Bouchard's nodes on PIP joints). Reduced range of motion and grip strength.

• Rheumatoid Arthritis (RA):

  • What it is: An autoimmune disease where the body's immune system mistakenly attacks its own tissues, primarily the synovium (the lining of the membranes that surround joints). This leads to chronic inflammation.
  • How it affects the hands: RA typically affects the small joints of the hands and wrists symmetrically (i.e., both hands equally). The most commonly affected joints are the knuckles (metacarpophalangeal, or MCP joints) and the PIP joints. Chronic inflammation damages cartilage and bone, leading to joint deformity over time.
  • Key symptoms: Persistent joint pain, swelling, and tenderness, often worse in the morning or after rest. Significant morning stiffness lasting more than 30 minutes. Fatigue, fever, and a general feeling of unwellness. Joint deformities, such as ulnar deviation (fingers pointing away from the thumb) or swan-neck/boutonnière deformities, can develop in later stages.

• Carpal Tunnel Syndrome (CTS):

  • What it is: A common condition caused by compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist.
  • How it affects the hands: The median nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger, and controls some muscles at the base of the thumb. Compression leads to nerve dysfunction.
  • Key symptoms: Numbness, tingling, burning, or pain in the thumb, index, middle, and half of the ring finger. Symptoms often worsen at night, waking the person from sleep. Weakness in grip strength, difficulty with fine motor tasks, and a tendency to drop objects. Shaking or flicking the hand may temporarily relieve symptoms.

• De Quervain's Tenosynovitis:

  • What it is: An inflammatory condition affecting the tendons on the thumb side of the wrist (specifically, the abductor pollicis longus and extensor pollicis brevis tendons) and their surrounding sheath. It's often an overuse injury.
  • How it affects the hands: Inflammation causes swelling and thickening of the tendon sheath, restricting the smooth gliding of the tendons.
  • Key symptoms: Pain and tenderness at the base of the thumb and wrist, radiating up the forearm. Pain is aggravated by gripping, pinching, or making a fist. Swelling may be visible. A positive Finkelstein's test (pain when making a fist with the thumb inside and bending the wrist towards the little finger) is characteristic.

• Trigger Finger (Stenosing Tenosynovitis):

  • What it is: An inflammatory condition where a tendon sheath in the palm becomes inflamed and thickened, forming a small nodule. This nodule catches as the finger flexes and extends.
  • How it affects the hands: The affected finger gets "stuck" in a bent position and then suddenly snaps straight, like pulling a trigger.
  • Key symptoms: Pain at the base of the affected finger or thumb, often worse in the morning. A popping or clicking sensation when bending or straightening the finger. The finger may lock in a bent position, requiring manual straightening.

• Gout:

  • What it is: A form of inflammatory arthritis caused by the accumulation of uric acid crystals in a joint.
  • How it affects the hands: While most commonly affecting the big toe, gout can also cause sudden, severe attacks of pain, redness, swelling, and tenderness in the joints of the hands, fingers, or wrist.
  • Key symptoms: Rapid onset of intense pain, often at night, accompanied by significant swelling, warmth, and redness in the affected joint. The joint may be exquisitely tender to touch.

Other Significant Causes of Hand Pain

Beyond the most common conditions, other factors and diseases can contribute to hand pain:

• Psoriatic Arthritis (PsA): An inflammatory arthritis that can affect some people with psoriasis. It can cause swelling of entire fingers or toes (dactylitis, or "sausage digits") and affect DIP joints.
• Lupus (Systemic Lupus Erythematosus - SLE): A systemic autoimmune disease that can cause widespread inflammation, including joint pain and swelling in the hands and wrists, often without joint destruction.
• Peripheral Neuropathy: Nerve damage due to conditions like diabetes, alcoholism, or vitamin deficiencies can cause burning, tingling, numbness, and pain in the hands and feet.
• Raynaud's Phenomenon: A condition where blood vessels in the fingers and toes constrict in response to cold or stress, leading to numbness, tingling, pain, and color changes (white, then blue, then red).
• Infections: Bacterial or viral infections can cause localized pain, swelling, and redness in a joint or soft tissue of the hand.
• Trauma/Acute Injury: While not a "disease," sprains, strains, fractures, or dislocations can cause acute hand pain and require immediate medical attention.

Understanding the Anatomy of the Hand

A basic understanding of hand anatomy is critical for comprehending the mechanisms of pain:

• Bones: The hand consists of 8 carpals (wrist bones), 5 metacarpals (palm bones), and 14 phalanges (finger bones).
• Joints: Key joints include the interphalangeal joints (DIP and PIP in fingers), metacarpophalangeal (MCP) joints (knuckles), and the carpometacarpal (CMC) joints (especially at the thumb base).
• Tendons: Strong, fibrous cords that connect muscles to bones, allowing movement. Tendonitis (inflammation of a tendon) or tenosynovitis (inflammation of the tendon sheath) are common causes of pain.
• Nerves: The median, ulnar, and radial nerves provide sensation and control muscle movement in the hand. Compression or damage to these nerves can cause pain, numbness, and weakness.

When to Seek Medical Attention

While mild, transient hand pain may resolve with rest and conservative measures, certain signs warrant prompt medical evaluation:

• Sudden onset of severe pain, swelling, or deformity.
• Inability to move a joint or bear weight.
• Numbness, tingling, or weakness that persists or worsens.
• Signs of infection, such as redness, warmth, fever, or pus.
• Pain that does not improve with rest or over-the-counter medications.
• Symmetrical joint pain and stiffness, especially with morning stiffness lasting over 30 minutes.
• Pain accompanied by other systemic symptoms like fatigue, unexplained weight loss, or rashes.

General Management Principles (Non-Medical Advice)

For persistent or diagnosed conditions, medical treatment is essential. However, general principles can support hand health and manage minor discomfort:

• Rest: Avoid activities that aggravate the pain.
• Ice/Heat: Apply ice packs for acute inflammation; heat can help with stiffness and chronic pain.
• Elevation: Elevating the hand can help reduce swelling.
• Gentle Movement: Within pain-free limits, maintaining range of motion can be beneficial. Avoid forceful gripping or repetitive movements.
• Ergonomic Adjustments: Modify workspaces, tools, or daily activities to reduce strain on the hands and wrists.
• Splinting/Bracing: For certain conditions like carpal tunnel syndrome or De Quervain's, a splint can provide support and reduce nerve/tendon irritation.

Conclusion

Hand pain is a multifaceted issue with numerous potential causes, ranging from common degenerative conditions like osteoarthritis to autoimmune diseases such as rheumatoid arthritis and nerve entrapments like carpal tunnel syndrome. As exercise science professionals, recognizing the diverse origins of hand pain is crucial for appropriate client guidance and referral. While general principles of rest and ergonomic adjustment can offer relief, persistent or severe hand pain always warrants a thorough medical evaluation to ensure accurate diagnosis and effective management.