Focal or unilateral hand pain may result from following causes
- Trauma
- Overuse
- Infection
- Reactive Arthritis
- Crystal induced arthritis
- Tumors
By contrast, bilateral hand complaints suggest osteoarthritis or a systemic or inflammatory or immune etiology.
Patterns of joint involvement are highly suggestive of certain disorders.
The distribution of affected joints in the hand may provide important diagnostic information. Thus, osteoarthritis may manifest as distal interphalangeal and proximal interphalangeal joint pain with bony hypertrophy sufficient to produce Heberden’s and Bouchard’s nodes, respectively.
Pain, with or without bony swelling, involving the base of the thumb is highly suggestive of osteoarthritis.
In contrast, Rheumatoid arthritis tends to involve the proximal interphalangeal, metacarpophalangeal, intercarpal, and carpometacarpal joints with pain, prolonged stiffness, and palpable synovial tissue hypertrophy.
Psoriatic arthritis may also involve the distal interphalangeal, proximal interphalangeal joints and the carpus with inflammatory pain, stiffness, and synovitis. The diagnosis of psoriatic arthritis is suggested by nail pitting or onycholysis.
Soft tissue swelling may also be noted over the dorsum of the hand and wrist and may suggest an inflammatory extensor tendon tenosynovitis, possibly caused by gonococcal infection, gout, or inflammatory arthritis.
The diagnosis of tenosynovitis may be suggested by local warmth and edema and is confirmed when pain is induced by maintaining the wrist in a fixed, neutral position and flexing the digits distal to the metacarpophalangeal joints to stretch the extensor tendon sheaths.
Focal wrist pain localized to the radial aspect may be caused by DeQuervain’s tenosynovitis resulting from inflammation of the tendon sheath involving the abductor pollicis longus or extensor pollicis brevis. This condition commonly results from overuse or develops after pregnancy and may be diagnosed with Finkelstein’s test.
A positive result in Finkelstein’s test is present when local wrist pain is induced after thumb is flexed across the palm and placed inside a clenched fist and the examiner passively deviates the hand towards the ulnar side.
Carpal tunnel syndrome is another common disorder of the upper extremity and results from compression of the median nerve within the carpal tunnel to produce paresthesias in the thumb and the second, third, and radial half of the fourth fingers as well as sometimes, atrophy of thenar musculature.
Carpal tunnel syndrome is commonly associated with
- Pregnancy
- Edema
- trauma
- Osteoarthritis
- Inflammatory Arthritis
- Infiltrative disorders
Phalen’s Sign: Paresthesia in a median nerve distribution is induced or increased by pressing the extensor surfaces of the two flexed wrists against each another.
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