Hand and wrist problems: assessment and treatment

Pain at the base of the thumb may be related to osteoarthritis of the thumb base joint. This joint helps the thumb move opposite the fingers. Osteoarthritis here is also called rhizarthrosis. Some people first notice pain when gripping; others are troubled by limited movement. The finger joints can also be affected by osteoarthritis. An X-ray can show changes in the joints. On its own, however, it does not tell us how well you can use your hand or which treatment you need. Our osteoarthritis page explains why symptoms, examination findings and your personal goals need to be considered together. If several joints are swollen or morning stiffness is pronounced, an inflammatory joint condition also needs to be considered. This requires a separate assessment, which may involve rheumatology expertise.

Tendons need to glide as freely as possible during movement. At points subject to particular strain, they run through protective coverings called tendon sheaths. If these become irritated, movement may hurt and the area may swell. On the thumb side of the wrist, for example, inflammation of a tendon sheath may be involved. Sometimes a finger catches as it bends or straightens, then suddenly releases. These observations help with the examination but do not yet establish a particular cause. We want to know which movements trigger symptoms and whether the demands on your hand have recently changed. Our ‘Tendons and sports orthopaedics’ section explains the relationship between load tolerance, reducing strain and an appropriate gradual return to activity. You do not need to play sport for this to be relevant: repetitive everyday movements can matter just as much.

A hand that repeatedly develops pins and needles needs a different assessment from a single painful joint. Nerves can become compressed or irritated at different points. In carpal tunnel syndrome, this affects the median nerve at the wrist. Hand symptoms can also be related to a nerve at the elbow or to the cervical spine. Which fingers are affected, whether symptoms occur at night and whether you unexpectedly drop objects are therefore important clues. Our ‘Hand pain and tingling’ page explains this assessment in more detail. Recurrent or persistent changes in sensation should be assessed, especially if weakness is increasing. A similar sensation in someone else does not mean the same treatment will suit you. If symptoms extend from the neck down the arm into the hand, ‘Neck and arm pain and cervicobrachialgia’ may be the next useful page to read. It explains the connection with the cervical spine and distinguishes it from local nerve compression. Tingling alone is not a reason for treatment of the spine.

We begin by listening to your symptoms and carrying out a physical examination. We assess movement, painful areas, swelling and hand function. Depending on the question, we also test sensation and strength and examine neighbouring areas. For example, it matters whether you avoid gripping because it hurts or whether you cannot hold an object securely despite trying. Further tests depend on the findings. X-rays can clarify bone changes or an injury; ultrasound can help answer questions about joints, tendons and surrounding tissue. If we suspect a nerve disorder, an additional neurological examination outside the practice may be useful. Existing findings are taken into account. New imaging is helpful when it can answer an outstanding question and influence the next decision.

After the assessment, we discuss which goals are realistic. Would you like to sleep with fewer interruptions, return to handicrafts or manage the demands of your work more comfortably? Depending on the cause, the plan may include changes to activity, suitable exercises, an aid or pain treatment. A splint should serve a specific purpose and suit your findings. Keeping the hand immobilised long term or starting vigorous exercises on your own is not a universal solution for hand symptoms. We also discuss the limits of non-surgical treatment. If further specialist care appears necessary, we explain the question it needs to address. Mentioning a possible operation does not mean a decision has been made to proceed. Your findings, the results of treatment so far and the consequences of waiting longer are what matter.