Many conditions can affect the hands and fingers. In this article, we present some of the common ones.
Carpal tunnel syndrome is pressure on the median nerve causing pain over the wrist and fingers. This can lead to numbness, tingling, or weakness in the hand and fingers. These symptoms are usually found in the thumb, index, and middle fingers (Figure 1). It can also lead to atrophy of the hand and finger muscles.
Cubital tunnel syndrome causes pain in the small fingers and half of the ring finger. The pain originates at the medial elbow (Figure 2). It is increased pressure on the ulnar nerve at the elbow where the nerve passes under the medial epicondyle or “funny bone”. The connective tissue over the nerve will sometimes thicken, causing the patient to have numbness and tingling along the little finger and ulnar half of the ring finger. Ulnar nerve compression below the elbow can cause a “claw hand”.
Osteoarthritis is pain that typically affects the interphalangeal joint of the fingers and thumb. It is a degenerative joint disease causing gradual deterioration of the cartilage forming the joints of the hand (Figure 3).
Rheumatoid arthritis is pain located at the knuckles of the fingers and wrist bone on the side of the small fingers (Figure 4). Inflammation or irritation causes pain, swelling, weakness, and overtime, there will be a loss of the normal shape and alignment of the joints. The joints between the hand and fingers swell and move upward (dorsal subluxation). Tendons over the joints slip and cause the fingers to bend towards the little finger (ulnar drift).
Flexor tendonitis (trigger finger) is pain that may be located in the palm at the base of the finger. The condition affects the tendons of the fingers causing the finger to remain in the bent position when attempting to straighten it (Figure 5). The flexor tendon becomes thick and irritated as it slides through the tendon pulley causing a thickened nodule and triggering of the tendon.
De Quervain syndrome causes pain that is located over the radial (thumb) side of the wrist (Figure 6). Pain and swelling over the thumb side of the wrist that may cause difficulty in gripping with the thumb. Inflammation of the sheath of tunnel that surrounds the two tendons that control movement of the thumb.
Basal thumb joint arthritis is pain that is located at the base of the thumb (CMC joint). It is arthritis of the basal joint or thumb CMC (carpometacarpal) joint (Figure 7). Basal joint arthritis results in pain with restricted movement of the thumb across the palm.
It may be difficult to differentiate between De Quervain’s syndrome and basal thumb joint arthritis. The Finkelstein’s test is conducted by having the patient make a fist with the fingers closed over the thumb and the wrist is bent towards the little fingers. The hand is pulled so that the involved tendons are stretched, causing sharp, local pain if injury and inflammation are present (Figure 8).
The grind test is performed by axial loading, pushing and rotating the thumb metacarpal bone, grinding may be felt within the joint (Figure 9). Doctors may have to warn the patient about the pain that the patient may experience during the exam. These tests may be uncomfortable for the patient.
Flexor Tenosynovitis (Kanavel’s signs) causes pain that is located in the finger at the flexor tendon sheath (Figure 10). There are four Kanavel cardinal signs including uniform swelling of the entire finger, the finger is flexed, intense pain when attempting to straighten the finger (occurs early) and tenderness along the course of the tendon sheath. These signs usually indicate an infection of the tendon sheath. Antibiotics and surgery may be necessary to treat this infection.
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