Dupuytren's disease Nodules are present in the palm, which can be painful. The nodules eventually become painless cords, so Dupuytren's is regarded as a painless condition. Treatment in primary care Splints and anti-inflammatory drugs can be prescribed for carpal tunnel syndrome and De Quervain's syndrome. Steroid injections can be administered for carpal tunnel syndrome, but beware of injecting into the median nerve in the centre of the wrist - always inject slightly towards the ulnar from the midline.
All joints in the hand can be injected, but no more than three times as there is a law of diminishing returns - subsequent injections are never as good as the first. If symptoms persist, referral is indicated. OA is treated by the GP using the analgesic ladder, then steroid injections. When these fail, referral to a hand surgeon is indicated.
Thumb OA can be treated very successfully with a trapeziectomy and finger OA is treated by joint fusion or joint replacement. The pain in Dupuytren's disease abates with time. The only indication for surgery in this condition is finger contracture. Sign in. Register Now. Stay signed in.
This site is intended for UK healthcare professionals. Championing and informing general practice professionals. Wasting of the thenar eminence can confirm carpal tunnel syndrome. How young is the patient? OA tends to present in the 60s, while Dupuytren's disease is common in the 60s or 70s.
Where is the pain? When does the pain occur? During the day elevation, for example whilst driving, can cause exacerbation of symptoms and the pain can also travel into the forearm or even to the shoulder. As the neuropathy worsens, fine manipulative tasks become more difficult eg. Possible treatments for carpal tunnel syndrome are splints, steroid injection or surgical decompression.
In practice surgical decompression usually under local anaesthesia gives excellent long term relief to the majority, 3 with splints and injection used in mild cases.
Inflammatory change is most often gout or pseudogout related, the latter classically affecting the wrist. Joint aspiration with microscopic examination of synovial fluid can prove the diagnosis showing uric acid crystals present in gout and calcium pyrophosphate crystals in pseudogout. Gout can affect distal interphalangeal joints with x-rays often confirming joint destruction, and white deposits tophi may form.
Rheumatoid arthritis may affect any synovial lined area joints, flexor or extensor tendons. Its first presentation is variable but synovial proliferation leads to deformity of the wrist and digits and occasionally tendon rupture such as extensor tendons to little, ring finger and thumb and flexor tendon to the thumb.
It typically causes severe pain and swelling along the radial side of the wrist. Treatment involves restriction of movement with splints, steroid injection and, in the more severe cases, surgical decompression. Degenerative change weakens the joint capsule resulting in a mucous cyst and causing nail changes. Proximal interphalangeal joint involvement may be isolated but quite disabling. Wrist degenerative change is often secondary to previous injury such as scaphoid non-union or scapholunate ligament disruption.
However a minor injury can cause a sudden symptomatic increase although x-rays reveal long standing change. Sudden onset pain in the hand is always a cause for concern. Where associated with blunt or sharp trauma, fracture or division of tendon, nerve or ligament must be considered.
Sharp trauma can be especially misleading as what may superficially appear to be a tiny cut misleads as to the depth of penetration and possibility of tendon or nerve division.
Joint penetration eg. Other painful problems include a diverse range of conditions. Dupuytrens disease which is ultimately a fibrous contracture of the palmar fascia, often has tender nodules initially forming in the palm and this affects grip. Triggering of a digit caused by thickening of the annular pulley entrance of the tunnel system containing the digital flexor tendons is a common diagnosis causing mechanical symptoms. The locked digit in flexion needs to be forcibly straightened to recover movement and this action is painful.
It is often worse first thing in the morning. Early onset, especially in diabetic or rheumatoid hands is marked by severe tenderness over with steroid the base of the fingers palmar aspect where isolated synovitis is present around the flexor tendon at the tunnel entrance.
Complex regional pain syndrome can affect the hand after surgery, closed distal radial fracture or even a minor injury. Allodynia disproportionate pain , redness and hyperesthesia with swelling and stiffness of the whole joint are typical features. Examination requires careful palpation correlated with knowledge of basic anatomy. Remember, the examiners thumb tip is larger than some carpal bones so be specific as possible when examining the carpus—tenderness over the 1st carpometacarpal joint or just proximal and dorsal, the scaphotrapezial joint, may help distinguish osteoarthritis of these joints.
After careful palpation of bony structure to reveal bone or joint pathology, thoughts should turn to the ligaments and tendons. Thumb stability is vital to pinch strength and this can be compromised by the acute injury such as ulnar collateral injury at the metacarpophalangeal joint skiers thumb or degenerative changes.
The long flexor tendons cause flexion of the distal and proximal interphalangeal joints of the fingers with one to the thumb interphalangeal joint. Open or closed injury may cause tendon division eg. Tendons should be tested methodically with resisted flexion at thumb interphalangeal and finger distal interphalangeal joints. The fingers should then be held in extension to block the effect of flexor digitorum profundus releasing one finger at a time to check for flexor digitorum superficialis function at the proximal interphalangeal joint.
The extensors can also be damaged in closed injuries —commonly at the distal interphalangeal joint where inability to actively extend. These injuries are often missed and once joints stiffen become very difficult to treat.
Grasping the thumb and ulnar deviating the hand sharply causes pain over the radial styloid. Nerve function is next to be tested with a sensory and motor test for the median and ulna nerves. The median nerve supplies sensation to the radial three digits and innervates the abductor pollicis brevis muscle found at the base of the thumb, palmar aspect , which may be wasted in severe carpal tunnel syndrome. The ulnar nerve supplies sensation to the little finger and the majority of the small muscles of the hand intrinsics tested by asking the patient to spread or abduct their fingers against resistance.
The radial nerve has no motor power in the hand supplying sensation to the dorsoradial aspect. It is important to remember neck involvement as the cause of more distal presenting symptoms. A radicular pattern of involvement can point to a more proximal underlying cause such as cervical nerve root entrapment. Applying a heat pack, soaking in a hot bath or using topical balms, such as Tiger balm or Eagle balm can help to relieve thenar eminence pain. Tiger balm and Eagle balm work to heat the muscles due to to high concentrations of menthol, an active ingredient that soothes muscles.
Massaging the thenar eminence can provide effective pain relief, as well performing certain thumb and hand stretches that may be provided to you by a soft tissue Occupational Therapist.
For medical treatments, making an appointment with a soft tissue occupational therapist should be your number one priority.
A soft tissue Occupational Therapist may look at reliving your pain through treatment such as trigger point release, as well as myofascial release therapy or even dry needling if required. This may take a few sessions to completely release, however, a soft tissue Occupational Therapist may also prescribe you thumb and hand stretches to complement your treatment, and assist with your recovery.
Immobilisation may also play beneficial as a treatment option. Immobilising the thumb with kinesiology tape may reduce the amount of movement your thumb and thenar eminence muscles have to travel, and thus will reduce the amount of aggravation and inflammation within the area, reducing overall pain.
At Infused Health our highly trained Soft Tissue Occupational Therapists will use a hands on approach to help treat your injuries, conditions or any concerns you may have. You can make an appointment today by calling If mild pain is exhibited, basic treatment options may help alleviate pain 3 Ways To Get Muscle Thenar Pain Relief… The number one way to treat any muscle pain, is to identify what activity is aggravating the pain, and to cease the activity.
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