Hand pain

Making a decision about  carpal tunnel syndrome (CTS) - NHS

What is it? 

The carpal tunnel is a narrow passage in your wrist made up of small bones which lie below a tough band of tissue above. One of the nerves (the median nerve) that control the feeling and movement in the hand runs through the carpal tunnel. CTS occurs when the nerve is squashed within the carpal tunnel. CTS can occur with pregnancy, diabetes, thyroid problems, rheumatoid arthritis and other less common conditions, but most sufferers have none of these. 

CTS is a common condition that can cause pain, numbness and a tingling sensation in the hand, first (index), middle and ring finger. Sometimes the thumb can also feel weak. Symptoms usually develop gradually, starting at night. 

CTS can be diagnosed by a GP or physiotherapist from a clinical assessment. 

How is it managed? 

In some cases, the symptoms of CTS will resolve without treatment.  

For mild or moderate symptoms, non-surgical treatments are recommended including:

• Avoiding prolonged periods of time with your wrist bent, avoiding repetitive hand/wrist movements
• The use of a carpel tunnel wrist splint worn at night for 6 weeks
• A corticosteroid injection to reduce inflammation in the carpal tunnel. There may be a need for a second corticosteroid injection
• In more severe cases of CTS, or if non-surgical management has failed, surgery may be required to reduce the pressure on the median nerve. 

Visit this website to access a useful resource to find out more about CTS: https://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome 

What is it? 

The two tendons involved are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles of the thumb. These two muscles run side by side in their tunnel and both move the thumb away from the hand. The cause of De Quervain's Tenosynovitis is not known; however it is much more common in women. 

De Quervain's Tenosynovitis is characterised by pain and localised swelling at the base of the thumb and the thumb side of the wrist. Pain is often worse with activities that involve gripping and squeezing combined with bending the wrist, such as when squeezing out a cloth or lifting objects. This pain can spread into the thumb, up the arm and can be very limiting. 

How is it managed? 

There are several ways to manage De Quervain's Tenosynovitis including: 

• The use of a splint to rest the tendons for short periods of time
• Avoiding repeated or prolonged activities that aggravate the pain 
• The use of cold compress/ice therapy for 10minutes a few times a day (do not apply ice directly on the skin)
• The use of anti-inflammatory gels or analgesia as recommended by a GP or pharmacist 
• Exercises to gradually load the tendons. https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Exercises-for-De-Quervains-V2.pdf
• A corticosteroid injection can reduce pain and inflammation 
• In a small number of more severe cases or if non-surgical management has failed people with de Quervain's syndrome may be referred to a specialist to consider surgery. 

Useful resource to find out more about De Quervain's Tenosynovitis: https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome

Exercises: https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Exercises-for-De-Quervains-V2.pdf

What is it? 

The joint at the base of the thumb, the carpometacarpal joint (or the CMC joint) is one of the most common joints in the body to be affected by osteoarthritis.

When OA develops in a joint, the cartilage (the smooth lining of a joint) gradually roughens and starts to thin. The bone underneath the cartilage starts to thicken. The bony surfaces at the edge of the joints start to grow outwards (known as 'spurs') and excess fluid can be produced in the joint, causing the joint to swell. 

Common symptoms include: 

• Pain: usually felt as a sharp or aching pain at the base of the thumb. The pain is usually worse during movement and relieved by rest.
• Reduced strength: you may find it difficult to grip or to pick up objects as the muscles around your thumb may have weakened. 
• Stiffness: you may find that your thumb is stiff following periods of rest (e.g. first thing in the morning).
• Swelling: swelling may develop around the base of the thumb.  
• Deformity: in the later stages of OA the thumb joint may collapse inwards towards the palm.

How is it managed? 

There are several ways to manage OA thumb including:

• Joint protection strategies- finding different ways of doing certain activities to take the strain off painful joints. This may include spreading the load over several joints, using larger, stronger joints rather than putting the strain through your thumb, or avoiding gripping for long periods of time
• The use of a splint when completing painful activities for short periods of time. A thumb spica splint or a PUSH splint may be used
• The use of assistive devices - e.g. a variety of small aids and assistive pieces of equipment that are available to help you make certain day to day activities easier such as, jar twisters and openers
• The use of cold compress/ice therapy for 10minutes a few times a day (do not apply ice directly on the skin)
• The use of anti-inflammatory gels or analgesia as recommended by a GP or pharmacist
• Exercises to assist with reducing joint stiffness and to maintain the range of movement and strength of your thumb https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Base-of-Thumb-Osteoarthritis.pdf
• A corticosteroid injection may provide temporary relief
• In some cases, if conservative management has not been successful, a referral to a specialist may be considered to discuss surgical options.

Useful resource to find out more about OA thumb: https://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis

Exercises: https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Base-of-Thumb-Osteoarthritis.pdf

What is it? 

Trigger finger (stenosing tenosynovitis) is a painful condition that affects the tendons in the hand. Trigger finger occurs if there is a problem with the tendon or tendon sheath (tissue which surrounds the tendon), such as swelling, which means the tendon can no longer slide easily through the sheath's pulley system and it can become bunched up to form a nodule. This makes it harder to bend the affected finger or thumb. The tendon gets caught in the opening of the pulley and finger can click or lock painfully as it is straightened. 

Around two to three per cent of people develop trigger finger. While the cause of trigger finger is not known, certain factors may increase the likelihood of it developing. For example, it is more common in females, people who are over 40 years of age, people with certain medical conditions, such as diabetes or rheumatoid arthritis.

How is it managed? 

Mild cases can recover after a few weeks without any treatment; others can spontaneously re-occur for periods or become a chronic problem. 

There are several ways to manage trigger finger/thumb including: 

• The use of a splint day and night for short periods of time. This stops the tendon from repeatedly being forced through the pulley and may help to reduce your pain. Trigger finger splints can be purchased from Amazon. 
• The use of cold compress/ice therapy for 10minutes a few times a day (do not apply ice directly on the skin). 
• The use of anti-inflammatory gels or analgesia as recommended by a GP or pharmacist. 
• A corticosteroid injection can be very successful to resolve this issue. 
• In some cases, if conservative management has not been successful, a referral to a specialist may be considered to discuss surgical options.  

A useful resource to find out more about trigger finger/thumb: https://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb 

What is it? 

Terminal finger joints are the joints at the end of your fingers. When OA develops in these joints, the cartilage (the smooth lining of a joint) gradually roughens and starts to thin. The bone underneath the cartilage starts to thicken. The bony surfaces at the edge of the joints start to grow outwards (known as 'spurs') and excess fluid can be produced in the joint, causing the joint to swell. 

Common symptoms include: 

• Pain: usually felt as a sharp or aching pain. The pain is usually worse during movement and relieved by rest
• Reduced strength: you may find it difficult to grip or to pick up objects as the muscles around your fingers may have weakened
• Stiffness: you may find that your fingers are stiff following periods of rest (e.g. first thing in the morning)
• Swelling: swelling may develop around the terminal joints
• Deformity: small bony bumps can form on the outside of the joints. 

How is it managed? 

There are several ways to manage OA in the terminal joints of the fingers including:

• Joint protection strategies- finding different ways of doing certain activities to take the strain off painful joints
• The use of assistive devices - e.g. a variety of small aids and assistive pieces of equipment that are available to help you make certain day to day activities easier such as jar twisters and openers
• The use of cold compress/ice therapy for 10minutes a few times a day (do not apply ice directly on the skin)
• The use of anti-inflammatory gels or analgesia as recommended by a GP or pharmacist
• Exercises to assist with reducing joint stiffness and to maintain the range of movement and strength of your fingers https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Osteoarthritis-of-the-Fingers.pdf
• In some rare cases, if conservative management has not been successful, a referral to a specialist may be considered to discuss surgical options.

A useful resource to find out more about terminal finger OA: https://www.bssh.ac.uk/patients/conditions/23/terminal_finger_joint_arthritis 

Exercises: https://www.sussexmskpartnershipcentral.co.uk/wp-content/uploads/2021/11/Osteoarthritis-of-the-Fingers.pdf

Joint protection strategies for hand and finger OA 

There are six basic rules for protecting your joints:  

1. Respect pain  
2. Where possible, use larger, stronger joints  
3. Reduce the effort and force  
4. Find a balance between rest and activity  
5. Exercise in a pain free range  
6. Avoid positions of deformity during day-to-day activities. 

Respect Pain  

• Stop doing an activity before you get discomfort
• Pace yourself. This allows you to keep doing activities that you enjoy, rather than having to give them up
• Try to work out your own pain threshold. How long can you do an activity before you feel pain?  
• Avoid or do less of the activities that cause you prolonged pain.

Use larger, strong joints  

Here are some examples and ideas of how to distribute weight and load more evenly throughout your hands and arms:

• Slide heavy objects along kitchen tops/tables rather than picking them up
• Use your palms instead of your fingers to lift or push
• Use two hands and avoid excessive gripping with your thumb
• Keep as much of your hand as possible in contact with the object you are carrying.

Reduce the effort and force during a task 

• Where possible, ask for help!
• Try and use appliances and assistive devices; these can help make day-to-day tasks easier by reducing strain on your joints
• Use padding to build up grips on items such as knives and forks or pens, to ease the pressure on the smaller joints in the hand. 

Balance rest and activity  

Many people give up on an activity if it causes them pain. By breaking the activity down and doing a little bit at a time, with adequate rest breaks, you may find that you won't have to stop doing something that you enjoy. Once you have developed a good understanding of your pain threshold and energy levels, try to use this guide below to manage your activities during the day.

• Take frequent breaks during an activity
• Avoid doing prolonged activities where you are unable to take a break
• Avoid staying in one position for a long time
• Alternate between heavy and light activities.

Exercise in a pain free range  

By making the muscles around your joints stronger you are less likely to develop pain in your joints and, in the longer term, joint deformities. Exercise can also help you to maintain your range of movement and decrease stiffness in the joints.

Try doing your hand exercises in warm water as this can help to relax the muscles in your hands, making it easier to do the exercises and to decrease pain in your joints.

Do not do any strengthening exercises if your joints are swollen and painful, or if you are having a flare up. If you get any pain that lasts longer than one hour after exercise, it may be that this exercise is too stressful for your joints. Discontinue the exercise.

Avoid positions of deformity 

Arthritis can sometimes cause deformities in the joints of the fingers and hands.

Use stable joint positions where possible. For example, when you are trying to pinch an object between your index finger and thumb, try to ensure that you maintain an 'O' position with these digits and keep your wrist straight.