Hand/Wrist Pain
Unilateral
Wrist Pain Predominant
Hand Pain
Cervical radiculopathy: Neck pain with positive Spurling test and numbness pending cervical spine level affected (see dermatomal distribution).
Pronator syndrome (median nerve compression at the elbow): Forearm pain. Sensory loss over thenar eminence. Weakness with thumb flexion, wrist extension, and forearm pronation.
Ulnar compressive neuropathy: Paresthesias of the 4th and 5th digits. Positive Tinel sign and compression tests at elbow and/or wrist (Guyon canal).
Finger Pain/Immobility
Finger injuries including
Mallet fracture
Jersey finger
Skier’s thumb
Infections including
Paronychia
Recent trauma painful swelling along proximal/lateral nail folds. Cuticle/nail dystrophy if chronic.
Chlorhexidine soak, mupirocin (Bactroban), I&D if abscess present. Topical corticosteroids vs. surgery for chronic cases.
Counseling: Maintain dry hands.
Trigger finger (stenosing flexor tenosynovitis): Due to constriction of first annular pulley overlying MCP joint
Initially painless, but now painful finger snapping/catching/locking
Naproxen 500 mg BID, triamcinolone injection q6 weeks x 2, referral to hand surgeon
Dupuytren's contracture
50+ y/o European male with personal h/o DM, smoking, alcohol abuse, exposure to repetitive hand tasks/vibration + family history of Dupuytren's contracture. Rubs palm to straighten fingers.
Range of motion exercises, triamcinolone/lidocaine injection, referral to hand surgeon for collagenase injection vs. open fasciectomy
Contracture of 4th/5th digits, painless palmar nodules, skin tethering/puckering
Bilateral
Peripheral neuropathy: History of diabetes mellitus. Bilateral, lower extremity involvement.
Raynaud syndrome: Symptoms related to cold exposure, characteristic color changes of fingers (white-blue-red). Nifedipine ER 30 mg daily (MDD 120 mg daily). Follow-up every 4 weeks until symptoms are controlled: Increase daily nifedipine dose 30 mg provided BP > 120/80 mmHg.