Pain in the hand indicates the presence of a pathological process in the bones and soft tissue structures of the distal upper limb. Sensations differ significantly in nature and duration, they can be weak, intense, sharp, dull, long-term, short-term. Sometimes there is a connection between pain and physical activity, other factors. To clarify the diagnosis, a survey, physical examination, radiography, CT, MRI of the hand, and other diagnostic procedures are carried out. Until the cause of the pain is determined, rest is recommended, sometimes analgesics are allowed.
A bruise of the hand occurs as a result of a blow or a fall, manifested by moderate gradually subsiding pain, swelling, and a slight limitation of the function of the limb. Possible bruising, abrasions. On palpation, local tenderness is noted, the symptom of axial load is negative. All manifestations disappear in 1-2 weeks.
Fractures of the II-V metacarpal bones are formed by a blow with a fist, a fall on a fist. V injuries predominate, sometimes in combination with a fracture of the IV metacarpal bone. Less common are injuries of the II, very rarely - of the III metacarpal bone. Fractures are manifested by sharp pain, which almost does not subside over time. The hand is edematous, especially in the projection of the damaged bone, often deformed. On palpation, a crunch, pathological mobility is determined. The function is drastically reduced.
When the first metacarpal bone is fractured, the diaphysis or the base of the bone suffers. In the first case, the maximum pain is found in the central part of the thenar, in the second (with Bennett's fracture) - just above the wrist joint. Bennett's fracture is accompanied by displacement of the distal fragment of the metacarpal bone, external deformation of the thenar base. An active grip with the participation of the first finger is impossible, when you try to clench your hand into a fist, oppose the first finger, the pain increases sharply.
Fractures of the bones of the wrist are less common. Mostly the base of the hand swells. Depending on the type of fracture, the pain is localized:
Dislocations of the bones of the wrist are often combined with fractures, manifested by extremely intense pain, significant swelling, severe deformity of the hand. The functions of the hand are almost completely lost due to severe pain.
For de Quervain's disease (stenosing ligamentitis), pain in the area of the wrist joint is more typical, however, in half of the patients, aching or pressing pain also occurs in the thenar area, radiating to the thumb. At first, the pain syndrome is detected only with excessive abduction and extension of the first finger, then it begins to bother with any movements, sometimes it remains at rest.
Aseptic tendovaginitis of the tendons of the fingers of the hand begins acutely against the background of overload, manifests itself as constant pulling pain, aggravated by finger movements, accompanied by limitation of movements, mild swelling, hyperemia. When the process is chronic, the intensity of pain decreases, they are observed only during exercise, patients complain of a feeling of a reduced hand.
Hygromas often form on the back of the wrist joint, but can also be located on the palmar side of the hand. Initially, they are usually painless, with active movements of the brush, pressure of a solid object, slight or moderate pain may occur. Unlike the formations of other localizations, palmar hygromas are distinguished by a significant density, they can resemble bone outgrowths.
Pain in the hand
Water callus is formed on the palmar surface in the area of the heads of the metacarpal bones, is the result of unusual or too long work with the instrument. First, there is mild local pain, slight swelling, redness. Then a bubble forms on the palm, the pain becomes intense, jerking, stabbing, cutting, aggravated by movement, touch. After opening the bladder, a painful wound appears.
When a wound becomes infected or microbes enter the bladder through cracks in the skin, a corn abscess develops with rapidly growing pains that take on a twitching, pulsating character. The pain is disturbing at night, aggravated by pressure, lowering the arm, accompanied by a slight increase in temperature, swelling of the back of the hand. With a breakthrough of pus into the surrounding tissues, the condition worsens even more, the pain becomes diffuse, weakness is noted, the temperature reaches febrile numbers.
Furuncles and carbuncles in the area of the hand are rarely formed, more often detected in men, located on the back surface of the segment. Accompanied by increasing local pain, which becomes very intense for several days, arching, twitching, depriving the night of sleep. An external examination reveals a limited purulent focus with a diameter of up to several centimeters of a bluish-purple color with one or more necrotic rods.
Phlegmon of the hand is usually a complication of panaritium, infected wounds and abrasions. Accompanied by strong twitching diffuse pains, depriving sleep, preventing any movement of the brush. Weakness, hyperthermia, symptoms of intoxication are noted. The edema is more pronounced on the back side, a pillow-shaped seal is determined on the palm, the fingers fan out to the sides.
Hematogenous osteomyelitis rarely affects the bones of the hand; post-traumatic and postoperative forms of the disease are more typical for this localization. Pathology is manifested by the appearance or intensification of pain, progressive edema, hyperemia, deterioration of the general condition, weakness, hyperthermia. The pains are sharp, jerking, tearing, clearly localized, so severe that the patient avoids any movement of the limb.
Rhizarthrosis of the 1st finger (arthritis of the 1st metacarpophalangeal joint) is manifested by pain at the base of the thumb. Initially, the pain is short-term, appearing at the beginning of movements and after exercise. Subsequently, the duration and intensity of the pain syndrome increase. The joint is deformed, the opposition of the 1st finger is broken, which leads to a limitation of the function of the limb.
After single gross injuries or repeated microtraumas, arthrosis of the wrist joints develops with racemose restructuring of the bone tissue. At the initial stage, patients complain of heaviness in the hands, clumsiness of the hands, short-term tingling pains without a clear localization. Then the symptoms become permanent, after the breakthrough of the cysts they are replaced by acute pain, swelling and dysfunction.
In rheumatoid arthritis, the interphalangeal joints are usually affected first, then inflammation in the metacarpophalangeal joints joins. Along with pain in the fingers, there is pain in the distal parts of the hand and the wrist joint. The pains are at first periodic, then prolonged, combined with morning stiffness. Palpation of the brushes is painful, "rice bodies" are often palpated. In the later stages, gross deformities are detected.
Arthritis in polymyositis is detected in 15% of patients, characterized by pain in the joints of the hand and fingers. The pain is moderate, dull, aching, periodic, combined with swelling, redness, limitation of movement, deposition of calcifications. Deformities are usually absent. The main manifestation of the disease are muscle pain and muscle weakness.
For hydroxyapatite arthropathy, constant dull pains that worsen at night, morning stiffness, and slight swelling of the joints are typical. There may be manifestations of tenosynovitis or a course of the type of carpal tunnel syndrome with shooting pains in the palm, radiating to the fingers and forearm. Deformations are not formed.
The bones of the hands are more often affected by benign neoplasia - osteoid osteomas and chondromas. Osteoid osteomas are accompanied by sharp local pain, less often they are asymptomatic. With chondromas, pain is vague, indistinct, non-intense, slowly progressing as the neoplasm grows. Malignant tumors of the hands are uncommon.
When the nerves are affected, the pain in the hand is burning, shooting. Often spread to other parts of the limb, combined with muscle weakness, trophic disorders, sensitivity disorders. They appear under the following conditions:
Pain in the hands can also appear with some neurotrophic pathologies: shoulder-hand syndrome, scalenus anterior syndrome, cervicocostal syndrome. Pain in the distal upper limb is characteristic of cervical osteochondrosis, intervertebral hernia, spondylarthrosis, and other diseases of the spine.
Occupational neurosis, some neurological and mental pathologies are accompanied by the appearance of writing spasm - pulling, aching pain in the hand that occurs when writing, typing, combined with convulsions, trembling, weakness of the distal limbs. In addition, pain in the projection of the hand is observed in the following pathologies:
Determining the causes of pain syndrome is carried out by orthopedic traumatologists. To make a diagnosis, the results of a survey, physical examination, instrumental and laboratory techniques are used. May be assigned:
An examination by a specialist is required for an accurate diagnosis.
Fractures and dislocations are fixed with a splint, cold is applied. For all injuries and diseases accompanied by swelling of the limb, an elevated position of the hand is recommended. With intense pain, give an analgesic. In most cases, the pain syndrome is reduced at rest, so patients are advised to reduce motor activity (except in cases where pain is relieved by movement). With increasing acute pain, hyperthermia, intoxication, an urgent consultation with a doctor is indicated.
In case of dislocations and fractures, local anesthesia, reduction, and fixation with a plaster cast are performed. Patients with injuries and diseases of the hand are prescribed:
Taking into account the characteristics of the pathology, the following surgical interventions can be carried out:
In the postoperative period, dressings are performed, painkillers and antibacterial agents are prescribed. They make up complex rehabilitation programs, issue referrals for sanatorium treatment.