Clearing's Chronic Pain Blog
2022 Guide to Chronic Pain Conditions of the Hand and Wrist
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Healthy hands and wrists are something we tend to take for granted. We don’t realize how important they are until they get injured. From small tasks like opening a door to complicated movements like typing on a keyboard, our hands and wrists help us out so much. So any hand or wrist pain has the potential to significantly affect our quality of life.
Chronic pain conditions of the hand or wrist typically come from issues affecting the joints, nerves, tendons, or other connective tissue.
Types of hand and wrist pain
Although the hands and wrists are smaller body parts, they are fed by three major nerves and contain dozens of bones, muscles, joints, and over 100 ligaments and tendons. So it’s not surprising how susceptible they are to injury, especially given how often we use them.
Below is an overview of the most well-known types hand and wrist pain, including:
- Carpal tunnel syndrome
- Tendon problems: tendonitis and tenosynovitis
- Dupuytren’s contracture
The most common cause of chronic hand or wrist pain is arthritis. Arthritis is a family of diseases involving inflammation of the joints. It results in joint swelling, pain, stiffness and decreased range of motion. The changes usually develop slowly and affect the hips, knees, hands and wrists.
In the United States, 23 percent of adults have arthritis, and more than one in four report severe joint pain. Arthritis in the hands can affect hand dexterity, grip strength and the ability to pinch or hold objects between the fingers and thumb.
Osteoarthritis (OA) is the most common type of arthritis, affecting around 32 million Americans. It occurs when the protective cartilage that cushions the ends of the bones wears down over time and the bones begin to rub together. For this reason, it is known as a disease of “wear and tear” that affects people as they age.
The incidence of OA may be even higher than current estimates and is projected to continue to rise as the population ages. One study calculated the lifetime risk of developing symptomatic hand osteoarthritis by the age of 85 to be 40 percent (compared to 45 percent for knee OA and 25 percent for hip OA).
Rheumatoid arthritis (RA) is another common type of arthritis that is known to cause chronic joint pain, including in the hand and wrist. RA has a very different origin than OA. Rather than being a disease of wear and tear, it is an autoimmune disease.
It’s estimated that around 1.5 million Americans have rheumatoid arthritis. Women are particularly susceptible, developing RA at three times the rate of men. 75 percent of people with RA will exhibit symptoms in their wrists.
Carpal tunnel syndrome
The carpal tunnel is a narrow passageway in the wrist, bordered by bones and connective tissue. Because these borders are quite rigid, the carpal tunnel cannot easily stretch or increase in size. The median nerve is one of the main nerves in the hand that provides feeling in the fingers, and controls the muscles around the thumb. It runs down the arm, through the carpal tunnel and into the hand.
Carpal tunnel syndrome is a common condition that occurs when the median nerve is squeezed as it travels through the wrist. This results in pain and numbness in the hand and arm. The compression of the nerve occurs when the tunnel becomes narrowed or when tissues surrounding the tendons swell, crowding the nerve.
Like rheumatoid arthritis, carpal tunnel syndrome is three times more likely to affect women than men, possibly because the carpal tunnel itself is smaller in women. Carpal tunnel syndrome is more likely to occur with age, with about 75 percent of cases developing in people between the ages of 40 and 70.
In most patients, carpal tunnel syndrome symptoms worsen over time. First, you may notice tingling and numbness in your fingers, and then weakness in your hand or fingers. This may be due to weakness in the muscles at the base of the thumb that are controlled by the median nerve. Over time, these feelings are likely to increase in frequency and severity.
Because of the progressive nature of carpal tunnel syndrome, early diagnosis and treatment are important. Early on, symptoms can be relieved by avoiding certain activities and wearing a wrist splint. But if pressure on the median nerve continues, it can result in nerve damage and chronic pain.
Tendons are fibrous bands of connective tissue that connect muscles to bones and contribute to joint stability. Strong and healthy tendons allow us to move easily.
Tendons are enclosed by tendon sheaths, which are tubes of connective tissue filled with a fluid that surround the tendons like a tunnel. When problems with the tendons or tendon sheaths develop, it can be very painful. Certain tendons in the body are more susceptible to injury, primarily those in the hands, feet, and wrists.
Tendonitis is the inflammation of a tendon which usually occurs from injury, strain or overuse of a tendon. It frequently affects athletes. While it can affect any tendon in the body, it is most likely to develop in the shoulder, knee, elbow, heel, wrist or hand.
Tendonitis causes acute pain and tenderness, making it difficult to move the affected joint. Most tendonitis injuries are temporary.
Tenosynovitis refers to the inflammation of the synovial sheath of a tendon, leading to joint pain, swelling and stiffness. It is especially common in the hands and wrists, and affects more women than men. Those with rheumatoid arthritis or diabetes are more likely to develop the condition.
Treatment for tenosynovitis depends on the origin of the condition. Usually, non-surgical methods are used to treat and manage the condition. But in more severe cases, surgical intervention may be considered.
The two most common types of tenosynovitis are DeQuervain’s tenosynovitis and stenosing tenosynovitis.
- DeQuervain's tenosynovitis, named after the surgeon who identified the condition, affects the sheath of the tendons in the thumb. As the tendons pass from the wrist into the thumb, they become irritated or inflamed.
- In stenosing tenosynovitis, the tendon sheath becomes inflamed and thickened, preventing free movement of the tendon. This prevents the affected finger from easily extending and flexing. The finger may suddenly lock in a bent position as if pulling a trigger, hence its nickname “trigger finger.”
Dupuytren’s contracture is a connective tissue disorder that develops gradually over years and can over time cause hand deformities. Sometimes called “the Viking disease” due to its prevalence in those of Northern European descent, it affects more men than women. Its prevalence rises with age, mostly seen in people over 50.
It is a condition that results in the thickening and tightening of the fascia – the fibrous layer of tissue that lies beneath the skin – in the palms and fingers.
Over time the thickened tissue can force the affected fingers to curl in toward the palm. This is called “contracture,” which makes it difficult to use the hand. In severe cases, the condition can lead to crippling hand deformities.
In the United States, the number of cases of Dupuytren’s disease numbered 16.2 million in 2010, with three million of those resulting in bent or disfigured fingers. Most people with Dupuytren’s do not experience pain from this condition.
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Causes of hand and wrist pain
Understanding the cause of hand and wrist pain conditions is an important step toward pain relief. The primary causes are:
- Lifestyle factors
- Strain and overuse
- Immune system dysfunction
Lifestyle factors like weight, activity and smoking can have a huge impact on hand and wrist pain pain conditions, such as arthritis.
Being overweight or obese can contribute to arthritic pain because the extra weight puts more pressure on weight-bearing joints. In addition, inflammatory factors associated with extra weight can worsen the inflammation that is characteristic of arthritis.
Staying active is critical for people who have arthritis. Keeping the muscles and surrounding tissue strong supports healthy joints, and activity keeps joints flexible and improves their range of motion. Low-impact exercises that involve your hands and wrists, like swimming and biking, are joint-friendly and encouraged. Another way to exercise your hand muscles and keep your joints flexible is through regular hand exercises.
We all know smoking is bad for you, but those who smoke should be aware of the link between smoking and arthritis. Smokers develop more joint damage than non-smokers and have a higher risk of developing rheumatoid arthritis. Smoking also blocks the development of new cartilage and decreases blood flow to the joints. And it increases the pain experienced by people who suffer from arthritis.
Fortunately, quitting smoking reduces the risk of developing severe RA.
Strain and overuse
When you’re doing the same action over and over, such as typing on a keyboard, these repetitive motions can contribute to carpal tunnel syndrome. Repetitive motion can lead to inflammation of the tendons in the finger and swelling of the synovium, squeezing the median nerve.
Along with carpal tunnel, overuse of the hands and wrists is believed to contribute to tenosynovitis.
Immune system dysfunction
A faulty immune system can contribute to some hand and wrist pain conditions. Rheumatoid arthritis, for example, is an autoimmune condition in which immune cells attack and wear away at the cartilage lining between the small bones of the hand and wrist.
In the case of Dupuytren’s disease, while the cause is not entirely known, some research indicates that an immune mechanism may be involved.
Treatments for hand and wrist pain
The hands and wrists are very prone to injury or inflammation of the joints, nerves, tendons and other connective tissue. The resulting pain can range from mild to severe. Early intervention provides the greatest chance of resolving the condition before it progresses. The following treatment options are popular, regardless of the stage of the condition and severity of pain:
- Over-the-counter medications
- Natural supplements
- Topical pain relievers
- Other at-home remedies
- Occupational therapy
Over-the-counter (OTC) pain medications are often taken by people with arthritis, especially acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen (Aleve), or ibuprofen (Advil). NSAIDs are a class of drugs that relieve pain, reduce inflammation and swelling, and bring down fevers. They work by blocking the production of certain chemicals in the body that can cause inflammation.
For arthritis sufferers, NSAIDs are generally more effective than acetaminophen because they have a stronger anti-inflammatory effect. Last year, the FDA approved the first combination NSAID and acetaminophen for pain relief, including from arthritis.
OTC oral pain medications have risks, however. Long-term use is linked to ulcers, stomach bleeding and increased risk of heart attacks. It’s always a good idea to consult with a doctor before starting any new medications.
Those who want to avoid long-term risks from OTC pain medications might prefer to seek relief from more natural sources, such as natural supplements or even CBD. There are many supplements that have anti-inflammatory or analgesic benefits, such as turmeric, ginger, omega 3’s and Vitamin D.
Topical pain relievers
Topical pain relievers like gels or creams concentrate active ingredients near the site of the pain, which can be especially effective for certain inflammatory conditions like arthritis and tendonitis. Topicals can be prescription, containing drugs like NSAIDs, or over-the-counter like Bengay. Topicals typically have high safety profiles and fewer side effects than oral pain medications.
More recently, topicals containing CBD for pain relief have been exploding onto the market. While research about the effects of topical CBD on people with arthritis is limited, some early evidence from animal studies suggests that topical CBD may help reduce inflammation, arthritis pain and chronic pain.
Dr. Jacob Hascalovici, MD, PhD, co-founder and Chief Medical Officer at Clearing explains: “Topical pharmacotherapy is one of the most effective treatments I prescribe routinely in my practice to treat arthritic pain, especially of the hands and wrists. They have an extremely favorable side effect profile, are very well tolerated and a great solution for on-the-go pain. Many of my patients carry prescription topicals in their purses.”
Other at-home remedies
Besides the remedies we’ve touched on above, there are other treatment methods you can try at home. These are especially helpful for tendonitis injuries.
- Resting and temporarily stopping any activities that use the affected tendon
- Icing the injury regularly
- Compressing the affected joint with a bandage to reduce swelling
- Stretching the area gently
- Wearing a splint or brace
Occupational therapy is a type of physical therapy that helps injured or disabled patients improve their ability to do daily activities. Hand therapy is a subtype of occupational therapy that helps patients regain use of their hands, wrists and arms. Conditions regularly treated by occupational hand therapists include tendonitis, rheumatoid and osteoarthritis, carpal tunnel syndrome and more.
Certain pain conditions of the hand and wrist may respond well to some injections. For tendonitis that becomes chronic, more aggressive interventions may be needed such as corticosteroid injections. Corticosteroids are powerful anti-inflammatory medicines which help ease swelling and inflammation. They can also relieve pain in carpal tunnel syndrome and in Dupuytren’s contracture.
Other nonsurgical treatment options for Dupuytren’s include enzyme injections into the palm to break down the fascial cords, and needle aponeurotomy, in which the contracted bands are cut or loosened with small needles.
In more severe cases of hand and wrist pain, surgery may be an option to help relieve pain, depending upon the condition. For more serious cases of tenosynovitis, surgical intervention may be considered. However, in cases of hand arthritis, surgery is rare due to the high failure rate and high risks, including nerve damage.
People with Dupuytren’s have a surgical treatment option called fasciectomy, which is the surgical removal of diseased connective tissue. The surgery can help the affected fingers move more freely. Fasciectomy can range from limited to more radical excisions, with partial fasciectomy being the most common.
There are always risks involved in surgery, however, and hand surgery complications can include damage to the nerves in the hand, which itself can result in chronic pain. If you have a chronic pain condition of the wrist or hand and would like to avoid surgery, we recommend exploring the options above.
The Clearing Solution
At Clearing, we offer a holistic approach to pain management, including for hand and wrist pain. We work closely with you to customize a treatment plan to bring you relief. Depending on the type of hand or wrist condition you have, your Clearing treatment plan may include our topical cream, which is especially effective for inflammatory pain like arthritis and some types of neuropathic pain. It may also include our custom blended nutraceutical full of natural ingredients that help decrease inflammation and support bone, joint and nerve health.
Our personalized comprehensive treatment plans can combine non-opioid prescription-strength topical creams, nutraceuticals, personalized exercises and high-quality care from our team of specialized providers. All available to you in the comfort of your own home via our telehealth platform and delivery. Click the button below to learn more about Clearing.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.