Hand Pain & Injury Information

What is the basic anatomy of the hand?
The hand is an extraordinarily complex part of the human anatomy. It is composed of 27 bones, including those in the wrist. The main parts of the hand include:
  • Carpals: eight bones in the wrist.
  • Metacarpals: five bones that form the palm of the hand.
  • Phalanges: 14 small bones that form the thumb and fingers.
  • Knuckles (metacarpal-phalangeal joint):  The fingers, composed of phalanges, join the palm, made of metacarpals.
  • Joints in the fingers are called the PIP and DIP joints. The PIP joint is the proximal interphalangeal joint and is the joint closest to the palm. The DIP joint is the distal interphalangeal joint and is the joint closest to the fingertip.
What is involved in a physical examination of the hand?
Most injuries of the hand will require an X-ray. Knowing how the hand was injured will help the doctor determine the problem. The doctor will touch your fingers, hand and wrist to determine the areas that are most painful and to evaluate any damage that may have occurred to the blood vessels, nerves or tendons in the hand.
What are common causes of hand pain?
At one time or another, just about everyone suffers from hand, finger or wrist pain. Symptoms result from everyday wear and tear, overuse, or injury.
What is arthritis?
Arthritis is a disease of the cartilage in joints. It can occur as a result of acute or chronic inflammation of a joint and its surrounding soft tissues, following trauma to the joint. Arthritis can also result from genetic or environmental causes.
What are the symptoms of arthritis?
Arthritis is frequently, but not always, painful and may result in limitation of motion, joint deformity, and loss of function.
What are the most common types of arthritis?
The two most common forms of arthritis are:
  • Degenerative arthritis or osteoarthritis: may affect one or more joints anywhere in the body. It usually occurs later in life and affects the hands and large, weight-bearing joints. Degenerative arthritis can cause pain, deformity and limitation of motion.
  • Rheumatoid arthritis: an inflammatory disease that can affect the entire body, especially the joints. It affects the synovium, the tissue which lines and nourishes joints and tendons throughout the body. The synovium proliferates, causing local destruction of bones, joints, and soft tissues.  Rheumatoid arthritis usually begins in the hands and feet and often spreads eventually involving multiple joints.
What are the causes of osteoarthritis?
 A number of factors contribute to the development of osteoarthritis. Mechanical considerations (e.g., joint stability and alignment) affect the distribution of forces across the joint and impact its joint longevity.
What are some of the risk factors for osteoarthritis?
Risk factors include traumatic injuries, joint infections, and heavy use. Some people inherit the tendency to develop degenerative arthritis, though this genetic predisposition is not well understood. Typically, these individuals are affected at an earlier age.
What are the causes of rheumatoid arthritis?
Although doctors aren’t sure of the exact cause of rheumatoid arthritis, it’s thought that it may result from a combination of genetics and environmental triggers. Some researchers believe a bacterial or viral infection can trigger the development of rheumatoid arthritis in someone who’s genetically susceptible.
What is Dupuytren’s disease?
Dupuytren’s disease, also known as “Viking’s disease,” changes the appearance of the hand and may make it difficult or impossible to use one or more fingers. It is an abnormal thickening of the tissue just beneath the skin in the palm and can extend into the fingers. Dupuytren’s disease occurs most often in people ages 50 and older. It often affects both hands and can sometimes affect the soles of the feet.
What are the symptoms and signs of Dupuytren’s disease?
Dupuytren’s disease gradually gets worse but rarely causes pain. Symptoms usually include lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Thick cords may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected.
What causes Dupuytren’s disease?
The cause of Dupuytren’s disease is unknown, but it may be associated with certain biochemical factors within the involved connective tissue.
What are the treatment options for Dupuytren’s disease?
Dupuytren’s disease is treatable but there is no cure. Sometimes, the disease may only affect the palm and not the fingers.

In mild cases, especially if hand function is not affected, only observation is needed.  For more severe cases, various treatment options are available in order to straighten the finger(s). These options include:
  • Collagenase injections, which weaken the Dupuytren tissue, and make it possible to manipulate the finger to make it straighter.
  • Needle aponeurotomy, which involves placing a needle beneath the skin to cut the Dupuytren’s tissue. 
  • Open surgery.
Both collagenase injections and needle aponeurotomy are office procedures.  Your hand surgeon can describe these options in more detail, including potential risks and benefits, to help you decide what treatment method is best for you.
What is de Quevain’s disease?
De Quervain’s disease is a painful inflammation of the tendons in the thumb that extend to the wrist. The swollen tendons and their coverings rub against the narrow tunnel through which they pass.
What causes de Quervain’s disease?
Often, the cause of de Quervain’s disease is unknown, but overuse, a direct blow to the thumb, repetitive grasping, and certain inflammatory conditions such as rheumatoid arthritis can all trigger the disease. Gardening, racquet sports, and various workplace tasks may also aggravate the condition.
Who is most likely to gets de Quervain’s disease?
While anyone can get de Quervain’s, it affects women eight to ten times more often than men.
What are the symptoms of de Quervain’s disease?
A: De Quervain’s disease commonly causes pain at the base of the thumb and extending into the lower arm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects. Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people feel pain if direct pressure is applied to the area.
How is de Quervain’s disease diagnosed?
Doctors most frequently perform the “Finkelstein” test to diagnose de Quervain’s disease. This test requires the patient to make a fist with their thumb placed in their palm. When the wrist is bent toward the outside, the swollen tendons are pulled through the tight space and stretched. If that movement is painful, it may be an indication of de Quervain’s disease.
How is de Quervain’s disease treated?
Treatment of de Quervain’s usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area.  It’s also recommended that patients refrain from any activities that aggravate the condition. Ice may be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication such as naproxen sodium or ibuprofen, or may inject the area with steroids to decrease pain and swelling. If de Quervain’s disease does not respond to conservative medical treatment, surgery may be recommended.
What is trigger finger or trigger thumb?
Trigger finger or trigger thumb occurs when the flexor tendon and the tissue that covers it become inflamed and swollen. Both are painful conditions that cause the fingers or thumb to catch or lock in a bent position.
What are the symptoms of trigger finger?
One of the first symptoms may be soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when attempting to flex or extend the affected finger. This catching sensation tends to worsen after periods of inactivity and loosen up with movement.

In some cases, the finger or thumb that is affected locks in a flexed position or in an extended position as the condition becomes more severe, and must be gently straightened with the other hand. Joint contraction or stiffening may eventually occur.
What causes trigger finger?
The problems often stem from inflammation of tendons that are located within a protective covering (the tendon sheath). Trigger finger may be caused by highly repetitive or forceful use of the finger and thumb. Medical conditions that cause changes in tissues, such as rheumatoid arthritis, gout, or diabetes, may be a culprit. Prolonged, strenuous grasping, such as with power tools, may aggravate the condition.
Who gets trigger finger?
Farmers, industrial workers, and musicians are frequently affected by trigger finger since they rely on their fingers or thumbs for multiple repetitive movements. Trigger finger is more common in women than in men and tends to occur most frequently in people who are between 40 and 60 years old.
How is trigger finger diagnosed?
Trigger finger can’t be diagnosed using X-rays or lab tests. It is generally diagnosed following a physical examination of the hand and fingers.
How is trigger finger treated?
The first step to recovery is to limit activities that aggravate trigger finger. Occasionally, your doctor may put a splint on the affected hand to restrict the joint movement. If symptoms continue, anti-inflammatory medications, such as ibuprofen or naproxen sodium, may be prescribed. Your doctor may also recommend an injection of a steroid medication into the tendon sheath. If the condition does not respond to conservative measures or consistently recurs, surgery may be recommended.
How long does recovery from trigger finger take?
The time it takes to recover from trigger finger depends on the severity of the condition. The choice of treatment also impacts recovery time. For example, splinting may be necessary for six weeks. However, most patients with trigger finger recover within a few weeks by resting and limiting the use of the affected finger and/or using anti-inflammatory medications.
What is a scaphoid fracture of the wrist?
A scaphoid fracture is a break in a small bone on the thumb side of your wrist. Of the eight carpal bones in your wrist, your scaphoid bone is the most likely one to break.
What causes a scaphoid fracture?
Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. They can also occur when your wrist twists severely or is hit very hard. Scaphoid fractures often happen while playing sports such as football, soccer, or basketball or during activities such as rollerblading, skateboarding, or bike riding.
What are the symptoms of a scaphoid fracture?
Because most scaphoid fractures are not outwardly visible and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, you may have:
  • Pain, tenderness, or swelling on the thumb side of your wrist.
  • A hard time grabbing or gripping things or moving and twisting your wrist or thumb.
  • Bruises around your wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken. If you have fallen on an outstretched hand and your wrist hurts, be sure to see a doctor to find out if you have any broken bones. Scaphoid fractures that are not treated properly can lead to long-term problems.

How is a scaphoid fracture diagnosed?
Your doctor will ask you questions about your symptoms and about how and when you hurt your wrist. He or she will examine your wrist for any swollen or tender areas, and check the mobility of your wrist and thumb. Your doctor will also try to find out how well blood is flowing to your hand and if you have any nerve damage in your wrist.

Most likely, your doctor will order X-rays of your wrist. Sometimes an X-ray clearly shows a scaphoid fracture. Other times, an X-ray may not show signs of a fracture. If your doctor is not sure if your wrist is broken, he or she may refer you to an orthopedist, a doctor who specializes in bone problems. Because evidence of fractures may not be seen right away, you may need a follow-up X-ray in one to two weeks. In the meantime, to prevent possible long-term problems, you will be treated as if you do have a fracture.
How is a scaphoid fracture treated?
It is important to find out if you have a scaphoid fracture, because scaphoid fractures need treatment to heal properly. With appropriate treatment and follow-up, most scaphoid fractures heal over time. Without treatment healing can be slow and difficult because parts of the scaphoid bone do not have a good blood supply. If your scaphoid bone does not heal well, you may develop long-term pain, stiffness, or arthritis in your wrist.