Pain in the hand and wrist can cause significant disability and affect the function of the hand.

The pain may be acute, as a consequence of an injury, causing either a sprain of the multiple ligaments found in this region or a fracture of one of the eight bones of the wrist (known as carpal bones), mostly the scaphoid bone or small bones of the hand.

Occasionally acute pain in the wrist and hand could also be infective in origin principally as soft tissue or joint infection. In other cases, wrist and hand pain can arise from inflammatory conditions such as rheumatoid arthritis or gout.

Arthritis

In elderly patients, pain in the region of the thumb and wrist mostly results from wear and tear or arthritis in the base of the thumb or from the small joints of the fingers. The thumb contributes to 80 per cent of the hand function, so it comes without saying that anycondition negatively affecting the thumb function will be detrimental to general hand use.

In elderly patients, pain in the region of the thumb and wrist mostly results from wear and tear or arthritis

Arthritis of the thumb base is a very common condition affecting mostly women. There is evidence of this condition in 80 per cent of patients aged over 80. In this condition the pain is worse with gripping, twisting or turning movements. There may be associated stiffness and, in advanced cases, wasting of the muscles around the thumb, causing weakness.

The condition is easily diagnosed with X-rays after an appropriate history and thorough examination. Most cases can be satisfactorily treated with physiotherapy, exercises and possibly a supportive splint. In cases resistant to non-interventional treatment, a steroid injection may be administered into the joint occasionally under ultrasound control.

Platelet rich plasma (PrP) injections, whereby a sample of the patient’s blood is extracted and centrifuged and the deposit injected into the offending joint, is also an option. The results with these injections are variable.

Surgery is a very safe and reliable option. In this operation, usually performed as a day case, the wrist bone at the base of the thumb is removed, allowing the body to produce a scar cushion in the void. This operation, called a ‘trapiezectomy’, may in some cases be combined with a creation of a suspension sling to stabilise the thumb.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a very common cause of wrist and hand pain. The condition is more common in women and presents itself with pain in the palm and wrist, occasionally radiating to the elbow and shoulder. This can be associated with altered sensations in the fingers, which wakes the patient at night. It is caused by compression of the nerve at the wrist – called the median nerve – and is associated with pregnancy, endocrine problems and wrist injuries.

The diagnosis is usually clinched by a history and examination but occasionally nerve tests are required in equivocal cases. The treatment may include splintage and surgical release of the nerve in a simple day case procedure performed under local anaesthetic.

Triggering

A relatively common condition of the hand affecting mostly patients with diabetes is a condition called ‘triggering’. In this condition, which may affect the fingers or thumb, the gliders develop a thickening and, as a result, catch on the mouth of the sheath that surrounds them.

This may result in pain, clicking or triggering of the finger, with the occasional inability to straighten the finger. Once again steroid injections around the thickening in the gliders can be effective. However, surgery in the form of a release of the sheath of the glider around the thickening may be required. This is usually performed under local anaesthetic as a day case.

De Quervain’s tenosynovitis

This may be a tongue twister of a name but refers to a condition named after the surgeon who described the disease. This is a painful condition which affects the long gliders around the thumb. The swelling in the two gliders causes the area to become inflamed, putting pressure on the nerves and causing pain, particularly with grasping or gripping. The condition may be treated with splinting, pain relief, physiotherapy, steroid injections or surgery to release the tight sheath around the tendons.

Alistair Pace is a consultant orthopaedic surgeon.