wrist & hand pain

Etiology

• tendonitis
  • de Quervain's tenosynovitis
  • wrist/finger extensor tendonitis
  • wrist/finger flexor tendonitis
  • intersection syndrome
• peripheral nerve entrapment
  • median nerve entrapment
    • carpal tunnel syndrome (motor &/or sensory)
    • pronator teres entrapment - generally sensory involvement alone
    • anterior interosseous syndrome (motor)
  • ulnar nerve entrapment
    • ulnar nerve entrapment at the wrist (Guyon's canal) (motor &/or sensory)
    • ulnar nerve entrapment at the elbow
• ganglion cyst
• sprain
  • ligament injury to the carpal bones
  • triangular fibrocartilagenous complex
  • radioulnar ligament sprain
  • carpometacarpal sprain
• fracture
  • carpal navicular fracture
  • scaphoid fracture
  • distal radius fracture
  • ulnar styloid fracture
  • other carpal fractures
• osteonecrosis (avascular osteonecrosis)
• arthritis
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • scleroderma
  • gout
  • pseudogout
  • psoriatic arthritis
  • septic arthritis
  • osteoarthritis

Clinical manifestations

• general
  • edema
  • echymosis
  • tenderness
  • deformity or atrophy
  • loss of motion
  • loss of strength
  • loss of sensation
  • crepitus
• atrophy of the thenar eminence suggests involvement of the median nerve
• atrophy of the hypothenar eminence suggests involvement of the ulnar nerve
• Tinel's sign
• Phalen's sign
• positive Finkelstein's test
• squeaking with movement suggests tendonitis
• popping or clicking with movement suggests cartilage tear of ligament laxity
• grinding sensation with movement suggests arthritis
• paresthesia, especially at night suggests nerve entrapment

Laboratory

• erythrocyte sedimentation rate (ESR)
• rheumatoid factor (RF)
• antinuclear antibody (ANA)
• joint aspiration (arthrocentesis)

Diagnostic procedures

• electromyography

Radiology

• plain radiographs:
  • all patients with a history of trauma & localized tenderness to palpation
  • may need to repeat in 2-8 weeks to rule out navicular or other carpal fractures
• magnetic resonance imaging (MRI)
• bone scan
• arthrography

Management

• relative rest, short term immobilization may be helpful
• pharmacologic agents a non-steroidal anti-inflammatory agents for 7-10 days
  • corticosteroid injections: short-term relief, but may cause tissue degeneration
• physical modalities:
  • ice, heat
  • high-voltage galvanic stimulation, iontophoresis, & phonophoresis (ultrasound)
• physical therapy with improvement in pain
• surgery
  • failure of 3-6 months rehabilitation
  • persistent pain at rest of with activities of daily living
  • unacceptable quality of life

More general terms

• arm pain

Additional terms

• anterior interosseous nerve syndrome; Kiloh-Nevin syndrome
• carpal tunnel syndrome (median neuropathy)
• de Quervain's tenosynovitis (stenosing tenosynovitis)
• Finkelstein's test
• intersection syndrome
• Phalen's sign
• scaphoid fracture
• Tinel's sign