Common Causes of Chronic Hand and Wrist Pain

Grasp a pen, unscrew the lid of a jar, throw a ball, drive your car, open the mail. We do these seemingly simple tasks so regularly that we don’t think much about what’s involved. But when our hands, wrists or fingers are causing pain, even the easy jobs can be challenging.

Dalibel Bravo, M.D., a board-certified, fellowship-trained orthopedic surgeon at Baptist Health Orthopedic Care.

Hand and wrist problems are extremely common. One study showed that more than 20 percent of visits to the emergency room for orthopedic complaints were related to hand or wrist pain. While many problems don’t require emergency care, seeing an orthopedic specialist is important because in many cases, early diagnosis leads to better treatment and puts you on the road to recovery quickly, says Dalibel Bravo, M.D., Baptist Health Orthopedic Care surgeon, who trained at NYU Langone Orthopedic Hospital and won the Chief Resident Best Paper Research Award. She was also awarded the Sarah Pettrone, M.D., Memorial Hand Surgery Scholarship Award, given to the resident who excels in hand surgery research.

“The hand and wrist are very complex, with many bones, muscles, tendons and ligaments,” says Dr. Bravo, who specializes in hand, wrist, shoulder and elbow surgery. “There are many different causes for hand pain and I really encourage everyone to see a specialist if they are experiencing pain, particularly if it is ongoing or worsening.”

Dr. Bravo recently presented “Chronic Hand Pain & Treatments,” a webinar hosted by Baptist Health West Kendall Baptist Hospital where she treats patients. In her presentation, she explained that the most common causes of hand pain are:

1. Carpal tunnel syndrome
2. Osteoarthritis
3. Tendonitis
4. Trauma or injury

Carpal Tunnel Syndrome

Caral tunnel syndrome, which is estimated to affect some 10 million Americans, is the number one cause of hand and wrist pain. It occurs when the median nerve, which provides sensation to the hand and fingers, is compressed.

As the nerve is squeezed, patients often experience numbness, tingling and pain in the hand and fingers. “It usually gets worse at night,” Dr. Bravo says. “Patients tell me it wakes them up and that it feels like their hand is on fire and they have to put their hand in cold water so it feels better.” If severe, carpal tunnel syndrome can lead to hand weakness and permanent nerve damage.

Risk factors include aging, obesity, diabetes, rheumatoid arthritis, thyroid problems and pregnancy. Some people have a congenital predisposition, an anatomical condition that runs in their family and makes it more likely that they will develop carpal tunnel syndrome. While it was originally believed that too much time at the computer, particularly typing, could cause carpal tunnel syndrome, research has disproven the theory. Jobs that require a heavy grip or use of tools that vibrate excessively, however, can aggravate the disorder.

Dr. Bravo says that diagnosis involves tests, including a nerve conduction study performed by a neurologist or physiatrist (a physical medicine specialist). Mild carpal tunnel can often be treated with a brace, over-the-counter pain medications or corticosteroid injections.

“Many patients are afraid because they hear the word steroid, but these injections are very safe and effective,” she says. “They are localized to the area, and do not lead to weight gain.”

If surgery is required, Dr. Bravo uses an endoscopic approach. Through a single, small incision in the wrist, she inserts a tiny camera and then cuts the ligament that is compressing the nerve. The procedure takes 10 to 15 minutes and patients recover quickly.

Osteoarthritis

A degenerative joint disease, osteoarthritis occurs when the cartilage that provides cushioning between the bones wears away. As the joint space narrows, bone begins touching bone, causing extreme pain. Not to be confused with rheumatoid arthritis, which is an autoimmune disease where the body’s own immune system attacks the joint, osteoarthritis usually occurs over time.

Dr. Bravo compares the wear and tear on the body’s cartilage to the mechanical elements of a car. “After a while, they start breaking down. There is no car that lasts 65, 75 years.”

Treatment for osteoarthritis may include anti-inflammatory medications, heat or ice, bracing, specific activity modification and exercises to keep active and steroid injections. While there is no cure for arthritis, there are different types of surgeries which can alleviate the pain.

Tendonitis

Tendons are rope-like structures that connect muscle to bone. They can become inflamed with overuse and in the confines of the wrist and hand, with little room for expansion, you may experience swelling, pain and loss of range of motion. Some of the common types of tendonitis or tenosynovitis are trigger finger, when inflammation around the tendon that bends the finger becomes inflamed and makes it difficult for patients to straighten their finger.

“It can happen to any finger,” says Dr. Bravo, “When the tendon sheath is enlarged, the finger can’t glide. You may have to manually straighten your finger.”

De Quervain’s tenosynovitis is another common form of tendonitis, often occurring from chronic overuse and repetitive motions (think lifting a child into a car seat, picking up grocery bags, playing golf). Pain and swelling below the base of the thumb is typical as is pain with movement of the thumb and wrist.

As with the treatment of many hand problems, rest, anti-inflammatory medications, corticosteroid injections, ice and the use of splints may help. Occasionally, surgery is recommended.

Trauma or Injury

Sprains and broken bones of the fingers, hands and wrists are commonplace. Falls, sporting activities and car accidents are among the causes. A broken bone, however, may not always result in disfigurement bruising or swelling.

“You’d be surprised how many people come in and say they had no idea it was broken, that they just thought it was a bruise,” she says. She also frequently sees jammed fingers in people who play basketball or other ball sports.

Depending on the severity of the injury, it could improve with bracing or splinting, or, if severe, may require surgery, including the insertion of plates and screws. Dr. Bravo specializes in the WALANT technique (wide awake local anesthesia no tourniquet), which allows patients to have surgery without general anesthesia.

It’s important to remember that hand and wrist problems can be different even if symptoms seem similar. “There is so much more to fingers and hands than people think. It could be a ligament sprain, something that involves tendons or a broken bone. If you have any doubt, get checked out,” Dr. Bravo urges.

For information on Baptist Health Orthopedic Care visit BaptistHealth.net/Ortho or call 833-556-6764.