Hands are important. They help make us who we are – Immanuel Kant called them ‘the visible part of the brain’. Losing function in our hands can be a source of huge frustration and affect every aspect of our lives. In this article, we look at some of the common causes of pain and stiffness in the hands and fingers.
1. Carpal Tunnel Syndrome
Characterised by pain, tingling and weakness in the palm of the hand, thumb, index and middle fingers, carpal tunnel syndrome (CTS) is a sign of increased pressure in the wrist.
This pressure, due to swelling or inflammation, compresses the median nerve (which supplies half the hand) as it travels through a bony passage in the front of the wrist.
Many people find the symptoms are worse at night, as fluid and inflammation build up during rest. Shaking the hand out can ease the pain and tingling.
Certain chronic conditions put you at risk of CTS, such as diabetes, underactive thyroid or rheumatoid arthritis. Pregnant women often experience a bout, due to fluid retention.
Other factors include narrowing of the carpal tunnel, perhaps due to trauma or osteoarthritis, or overuse from activities such as knitting, gardening or playing an instrument.
2. Tenosynovitis – De Quervain’s and Trigger Finger
Tenosynovitis is irritation and inflammation of tendons and their protective sheaths. It’s a common cause of pain and stiffness in the hand and fingers.
De Quervain’s (‘duh kwervains’) tenosynovitis affects tendons in the side of the wrist under the thumb, whereas trigger finger happens in the palm of the hand and affects one or more fingers – most often the ring finger.
If you have pain and swelling on the thumb-side of your wrist, you’re having trouble with gripping or pinching, and your thumb feels like it catches during movement, then it’s likely you have De Quervain’s tenosynovitis.
Alternatively, you’ll know you have trigger finger if it’s hard to straighten your bent thumb or finger, and it gives way with a sudden pop. You may also notice a lump in the palm, at the base of the affected finger.
The finger tendons in the palm should glide easily, but an irritated tendon can develop a swollen nodule. This becomes stuck under the connective tissue band in the palm, stopping the finger from re-straightening.
Trigger finger starts gradually, but can become severe, causing permanent loss of function if not treated.
Tenosynovitis, like CTS, is an overuse condition and more common in those with chronic health issues such as diabetes, overweight and arthritis. There’s a lot of overlap – in fact, De Quervain’s tenosynovitis happens more often in people who have carpal tunnel syndrome.
3. Dupuytren’s Disease
Although it also causes the fingers to become bent, Dupuytren’s (‘doo-pwee-trons’) disease differs from trigger finger and the other inflammatory conditions that cause pain and stiffness in the hands.
It’s a genetic condition that causes a thickening and tightening of the connective tissue in the palm. These thickened bands pull the fingers – usually the ring and little fingers – into a curled position, causing stiffness but not pain.
As well as the genetic component, there’s a link to ageing, smoking, drinking alcohol, having diabetes, or taking certain epilepsy medications.
Although it’s not serious, it can affect your day-to-day function. Fine motor skills can become difficult, reducing your ability to grip, write, and lift objects.
Thickened bands in the palm of the hand are a sign of Dupuytren’s disease.
There are several types of arthritis that can affect the wrists and hands.
Osteoarthritis is the most common. It tends to affect the base of the thumb and the small joints in the fingers, causing aching and stiffness. The joints enlarge and become knobbly, and you may notice the base of your thumb looks more pronounced or square.
Rheumatoid arthritis is an auto-immune condition that causes swelling and pain in many joints, including the wrist, knuckles, and mid-finger joints. In later stages, joint erosion can mean the fingers become pulled to one side.
Gout and pseudogout are forms of inflammatory arthritis caused by the body’s inability to break down certain compounds. These compounds form sharp crystals in the joints, irritating the joint lining and causing inflammation. Gout typically affects the big toe joint, and pseudogout the knee joint. However, both can affect the wrists and hands, causing significant pain, swelling and stiffness.
Similarly, psoriasis (an autoimmune condition that produces scaly skin rashes) can trigger inflammatory arthritis, which commonly affects the hands and wrists. A hallmark sign is ‘dactylitis’, where a whole finger becomes red and swollen – more commonly known as ‘sausage finger’.
Treatment options for hand pain and stiffness
The first step is always to get an accurate diagnosis. Your physiotherapist or osteopath are trained in diagnosing many causes of hand pain and stiffness, and will refer you to your GP if further tests are needed.
If your condition involves inflammation, your GP may suggest a steroid injection to reduce it. In more severe cases of carpal tunnel syndrome, tenosynovitis or Dupuytren’s disease, surgery to release the connective tissue can be effective.
However, you may wish to try some less invasive options first.
Manual therapies, such as osteopathy and physiotherapy, can reduce inflammation and swelling, ease pain and improve mobility.
Some conditions can be resolved entirely through a process of physical therapy, supervised exercise programmes, and changes to your activity.
Other conditions, such as Dupuytren’s disease or arthritis, have no cure, but your therapist can work with you to alleviate pain and stiffness and improve function.
Here at Woodside Clinic, we can also offer shockwave therapy. This gentle and pain-free technique uses low-intensity soundwaves directed through the skin to reduce inflammation in joints, tendons and other connective tissue. Research shows that shockwave therapy has significant benefits for the treatment of Dupuytren’s disease and CTS, and has shown promise for tenosynovitis and for pain relief in rheumatoid arthritis.
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Alternatively, if you’re ready for a session with one of our qualified therapists, you can book online.
We have many ways to help manage your hand pain and stiffness, so don’t suffer – speak to our team today.