Hand Pain: Causes by Location and Pattern

Hand pain by location

Common causes of hand pain

Osteoarthritis

Osteoarthritis of the hand is very common after 50, especially in women. It affects the joints at the ends of the fingers, the middle joints and the base of the thumb. Expect aching with use, brief morning stiffness, bony lumps at the finger joints and, at the thumb base, pain when gripping, turning keys or opening jars. See thumb arthritis.

Carpal tunnel syndrome

Carpal tunnel syndrome is compression of the median nerve at the wrist. It causes tingling, numbness and pain in the thumb, index and middle fingers, often waking you at night, and relieved by shaking the hand. Later, the thumb muscles weaken and you may drop things. It is common in pregnancy, diabetes, hypothyroidism and with repetitive wrist work.

Trigger finger

Trigger finger happens when a finger tendon catches in its sheath. There is a tender lump in the palm at the base of the finger, and the finger clicks, catches or locks bent, especially in the morning.

De Quervain's tenosynovitis

De Quervain's tenosynovitis causes pain and swelling on the thumb side of the wrist, worse with gripping, lifting and thumb movements. It is common in new parents who lift babies repeatedly.

Injuries

Sprains, fractures, dislocations, tendon injuries and cuts. A boxer's fracture of the little finger knuckle after punching is common. Skier's thumb (a torn thumb ligament) makes pinching weak and painful.

Inflammatory and other causes

• Rheumatoid arthritis: painful, swollen, warm knuckles and middle finger joints in both hands, morning stiffness lasting more than 30 minutes, and tiredness. Early treatment prevents joint damage.
• Psoriatic arthritis: swollen fingers ("sausage digits"), nail pitting and psoriasis.
• Gout: sudden attacks of a red, hot, very painful joint, sometimes in the hand or wrist.
• Raynaud's phenomenon: fingers turn white, then blue, then red in the cold or with stress, with numbness, throbbing and pain on rewarming. This is a common reason for hand pain when cold.
• Ganglion cyst: a firm, smooth, rubbery lump on the back or front of the wrist or base of a finger. It can feel hard and seem to move slightly under the skin. Most are painless, but some ache.
• Dupuytren's contracture: thickened cords in the palm that gradually pull fingers bent, usually painless.
• Cubital tunnel syndrome: ulnar nerve compression at the elbow, causing numbness and pain on the little finger side of the hand.
• Pinched nerve in the neck: neck pain spreading to the arm and hand with numbness in a specific pattern.
• Complex regional pain syndrome: severe burning pain, swelling and color changes after an injury.
• Heart pain: rarely, angina or a heart attack causes pain in the left arm and hand, usually with chest symptoms.

Right hand or left hand pain

Most causes affect either hand equally, but pain is often worse in the dominant hand because it does more work. Carpal tunnel syndrome and overuse injuries are common in the dominant hand. Pain in both hands at once points more to inflammatory arthritis, carpal tunnel in both wrists, Raynaud's or a body-wide cause.

How doctors find the cause

A doctor will ask exactly where it hurts, what makes it worse, whether you have numbness, stiffness, swelling or color change, about your work and hobbies, and about other joints. They examine each joint, tendon and nerve, including specific tests such as tapping over the carpal tunnel or stretching the thumb tendons.

Tests may include:

• X-rays for arthritis and fractures
• ultrasound for tendons, cysts and joint inflammation
• blood tests: inflammation markers, rheumatoid factor, anti-CCP, uric acid, thyroid function, blood sugar
• nerve conduction studies for carpal or cubital tunnel syndrome
• MRI for ligament injuries and hidden fractures

Treatment and home care

What you can do

• Rest from aggravating activities and take frequent breaks from repetitive tasks.
• Splints: a wrist splint at night for carpal tunnel, a thumb spica splint for thumb arthritis or De Quervain's.
• Ice for acute pain and swelling. Warmth (warm water soaks or paraffin wax) for arthritis stiffness.
• Gentle exercises: range-of-motion and grip strengthening, guided by a hand therapist.
• Joint protection: jar openers, thick-handled utensils and using larger joints to carry loads.
• Keep hands warm with gloves if you have Raynaud's, and avoid smoking.
• Pain relief: acetaminophen (paracetamol), or ibuprofen tablets or gel at the label dose. Avoid oral NSAIDs if you have kidney disease, stomach ulcers or take blood thinners.

Medical treatment

• steroid injections for trigger finger, De Quervain's, carpal tunnel and thumb arthritis
• disease-modifying medicines for rheumatoid or psoriatic arthritis
• urate-lowering treatment for recurrent gout
• surgery, such as carpal tunnel release, trigger finger release or thumb joint reconstruction, when other treatments fail

Frequently asked questions

Why does my hand hurt for no reason?

Hand pain without an injury is often from early osteoarthritis, carpal tunnel syndrome, tendon irritation from repetitive use, or trigger finger. Swelling and stiffness in several joints may mean inflammatory arthritis. If pain lasts more than two weeks, or comes with swelling or numbness, see a doctor.

Why does my hand hurt when it is cold?

Cold makes arthritis joints stiffer and more painful. If your fingers also turn white or blue and then red and throbbing as they warm, it is likely Raynaud's phenomenon. Keep your whole body warm, wear gloves, and see a doctor if attacks are severe or cause sores.

What is the hard lump on my hand that moves?

A firm, smooth, rubbery lump on the back of the wrist or base of a finger that seems to move under the skin is most often a ganglion cyst. They are harmless and often painless. Have any lump that grows, hurts or feels fixed and hard checked by a doctor.

Can hand pain be a sign of a heart attack?

Rarely. Heart pain can spread to the left arm and hand, but it nearly always comes with chest pressure, breathlessness, sweating or nausea. Call 911 if hand or arm pain comes with these symptoms, especially during exertion.

When should I see a doctor for hand pain?

See a doctor promptly for a hot, swollen hand, a bite, a cut that affects finger movement or feeling, or a deformed finger. Book an appointment for pain lasting more than two weeks, night-time tingling, locking fingers, or stiff, swollen knuckles in both hands.