Complex, the hand, with its many tendons, its network of nerves, and its many small bones and joints, become fragile over time.
Trauma may leave scars unless the wear of cartilage, inflammation or compression of a nerve is the cause of pain that can be very debilitating, during the day, by hindering mobility, or at night, by disturbing sleep. And it is not uncommon for several pathologies to be associated.
The decryption of the most common symptoms and solutions with Prof. Philippe Lavernia, head of the hand surgery department at the Strasbourg University Hospital.
It’s painful moving through the day.
Mobilizing the hand triggers sharp, localized pain. First possibility: one or more joints are affected by osteoarthritis, the most common degenerative disease. A cartilage has worn out, often by dint of movement or impact, the two bone ends are in contact, and any movement becomes painful.
This pathology can progress by periodic crises, accompanied by inflammatory episodes, which can also wake up punctually at night.
The second possibility is tendinitis caused by a traumatic effort or repeated gesture. A tendon then inflames and becomes painful on mobilization.
Solutions to relieve.
rest! It is a question of stopping time to repeat the movement responsible for the tendon’s inflammation or cartilage’s wear. Oral and topical anti-inflammatories calm the pain of tendonitis and osteoarthritis during attacks. The next step for both pathologies is that cortisone infiltrations give good results in 50% of cases and can be repeated thrice. In case of resistance and degradation, the operation is proposed to relieve osteoarthritis radically. It is a question of blocking once and for all the articulation when this one is not too much requested (at the end of a finger, for example) or to pose a small prosthesis.
It hurts to rest at night.
Nocturnal joint pain, which manifests itself in the hands, is typical of an inflammatory phenomenon that can evoke either a temporary attack of osteoarthritis, as we have seen or rarer rheumatoid arthritis that settles in the long course, leaving a continuous painful background, sometimes exacerbated by seizures. We think of it particularly if the two joints are a little red and swollen bilaterally at the first phalanges of both hands and the wrists.
But it also happens that a painful sensation in the last joints at the end of the fingers is caused by gout, generally due to an unhealthy lifestyle (too meaty diet and excessive alcohol consumption). It is characterized by uric acid deposits in the joints, causing swelling and redness. A first crisis manifests itself first in the big toe frequently, but the hand can also be immediately affected. It is better to treat without delay before the deterioration of the joints.
Solutions to relieve
great progress has been made to slow down the process of rheumatoid arthritis, with the development of biotherapies, sometimes complementing older treatments such as methotrexate. And to relieve, you can already wear a support orthosis at night; it is often very effective, and also try cortisone infiltrations. For polyarthritis and gout, the doctor also offers local and oral anti-inflammatories. As for gout specifically, it can also be treated with hypouricemic drugs that reduce uric acid.
It tingles, and you no longer feel the fingertips.
Increasingly intense tingling at night and upon waking, which can generate a burning sensation, evokes the famous carpal tunnel syndrome, which affects women more frequently around their fifties and after. When the flexor tendons of the hand increase in volume, under the effect of inflammation, they compress the median nerve, which passes nearby in the same tunnel. The fingers are then numb and lose sensitivity, gradually limiting all fine manipulations. The possible causes are multiple:
- Hormonal disturbances
- A secondary consequence of rheumatism
- Mechanical effects of bad posture and an often-repeated gesture in the professional context
- Badly reduced wrist fracture
Solutions to relieve
adapted means for each cause, by hormonal treatment, if necessary, or by stopping faulty movements, by arranging the workstation, for example. And limit the nocturnal symptoms, aggravated by a bad hand position, closed and folded fists, and wearing a splint that keeps the wrists open makes it possible to limit the nerve compression and associated tingling. Corticosteroid infiltrations have also been proven, but their results are variable. The operation is proposed to release the nerve in the absence of lasting relief.
It’s painful when you get stuck.
We flex the fingers, we want to open the hand, and the tendon seems to snap painfully in the palm. It’s probably a “trigger finger” caused by a small ball forming on the tendon, which can be felt by touch and blocked by sliding on a kind of internal pulley. Apart from a congenital origin resulting in an early manifestation in the baby, the trigger finger mainly concerns adults after a shock or effort, generating a simple tendinitis with localized synovitis responsible for the olive-shaped lump.
The solutions to relieve.
we start by acting on the cause of the tendinitis by putting the hand at rest. Infiltrations also provide relief in 50% of cases. And if not, we operate by cutting the “pulley” to release the tendon.