Orthopedics-Online

Pain in the back of the hand

General

There are numerous causes of pain in the back of the hand. The most common include tendinitis, carpal tunnel syndrome and the so-called RSI syndrome.
But joint or tendon injuries as well as osteoarthritis or gout can cause pain in the back of the hand.
The cause can usually be found with suitable imaging.
The therapy for pain in the back of the hand ultimately depends on the underlying disease.

Causes of back hand pain

The causes of pain in the back of the hand are very diverse and often they do not lie in the back of the hand itself. Conceivable causes are generally injuries to the back of the hand, the wrist and other parts of the hand, degenerative changes or inflammation. The following is an overview of possible causes of pain in the back of the hand.

Carpal tunnel syndrome

The carpal tunnel syndrome is a so-called compression syndrome in which the median nerve in the carpal canal is compressed.
The carpal canal is a bony canal in the area of the wrist, which is additionally bounded by ligaments. If there is an increase in pressure in the canal, for example due to tissue swelling, inflammation or given anatomical tightness, the median nerve can be pinched.
This typically leads to abnormal sensations in the supply area of the nerve, including e.g. the thumb belongs, but also to motor disorders and pain.

The pain can radiate diffusely from the wrist into the arm and the rest of the hand, so that the back of the hand can also hurt with advanced compression. Initially, the symptoms occur more frequently after exercise, such as grabbing or lifting heavy loads. Later, however, the pain also occurs at rest.
Diagnosis is based on a physical examination and measurement of the nerve conduction velocity of the median nerve, which is decreased in carpal tunnel syndrome.
Both conservative and surgical measures are used for therapy. In conservative therapy, splints, anti-inflammatory and analgesic drugs are used. Corticoids are also used in therapy because of their anti-inflammatory effects. There are various surgical techniques in surgical therapy in which the median nerve is relieved.

Read more on this topic at: Carpal tunnel syndrome

Tendinitis

The tendonitis, too Tendovaginitis called, is a fairly common disease occurrence. In principle, tendinitis is possible wherever there are tendon sheaths or tendon fans. The wrist and tendon fans of the extensor tendons on the back of the hand are particularly often affected. There are six tendon compartments on the back of the hand through which nine muscle tendons run. If these tendon compartments become inflamed, the back of the hand hurts, but the pain can spread to other parts of the hand.
There are both infectious and non-infectious causes of tendinitis in the back of the hand. Infectious tendon sheath inflammation usually occurs after stab wounds or other injuries to the hand that allow pathogens to penetrate the tendon sheaths. Non-infectious causes are mainly constant stress on the tendon sheaths (for example through exercise). The hand is particularly stressed by poor posture and non-ergonomic computer work, so that office workers, for example, have tendonitis more often.
In acute inflammation, the affected tendon compartment is tender on pressure and can be partially swollen, red and overheated. The pain in the back of the hand can also occur at rest and shows little improvement through immobilization.
In the case of chronic inflammation, a knotty thickening can also develop on the tendon, which can also be felt under the skin. In addition, there may be crunching and friction noises when moving.
In the clinical examination, the doctor palpates the painful back of the hand and can determine which tendons are affected based on the localization of the pressure pain. In addition, if anything is unclear, MRI and ultrasound diagnostics can be used to map the focus of inflammation. If the doctor suspects that the inflammation was caused by a rheumatic disease, he will also determine the relevant blood parameters using blood samples.
The treatment of tendinitis is usually carried out. conservative. It is important to protect the affected tendon and to immobilize it. The latter can be achieved, for example, with splints and stabilizing bandages. Sufferers can also apply anti-inflammatory creams and take pain relievers and anti-inflammatory drugs. These include the NSAIDs (non-steroidal anti-inflammatory drugs) such as. Aspirin or ibuprofen. In addition, occupational therapy and physical therapy can provide relief. In the case of very severe and chronic complaints, local anesthetics (Local anesthetics) and cortisone supplements are used to reduce inflammation and pain. In rare cases, surgery is performed.

You can also read more on this topic at: Tendinitis

Repetetive Strain Injury Syndrome / RSI Syndrome

In medicine, one speaks of RSI syndrome when painful complaints such as arm, neck and hand complaints occur after repetitive activities. Colloquially, this is also known as secretary's disease or mouse arm.
It must be differentiated from specific clinical pictures such as carpal tunnel syndrome or tendinitis.
Especially with office workers and other employees who often carry out such activities (e.g. computer work), back pain can be traced back to an overload of the hand. This can be prevented by taking sufficient breaks, a good sitting position and an ergonomic workplace. The therapy corresponds roughly to that of tendinitis. The affected hand should be spared. If the pain is severe, pain relievers and anti-inflammatory drugs can help.

Read more on this topic at: RSI syndrome

Carpal arthrosis

Carpal arthrosis is a degenerative disease (caused by wear and tear) that usually develops in the joint between the forearm bones and the carpal bones. Injuries to the wrist can, for example, lead to a slight misalignment of the carpal bones and thus cause osteoarthritis after a long time. Chronic overloading of the wrists and wrist can also cause such osteoarthritis. It is not uncommon for carpal arthrosis to occur in connection with inflammatory diseases. Due to the wear and tear of the articular cartilage, greater friction is placed on the carpal bones, which can lead to (load-dependent) pain in the wrist and back of the hand.

Read more on this topic at:

Wrist pain
Wrist osteoarthritis

Fracture / broken bone

A fracture of the wrist or metacarpal often causes pain on the back of the hand. Typically, such fractures occur as a result of a fall that is caught with the hands. These cause pain, especially when the hand is moved. Other accident mechanisms, such as getting your hand caught in a door, can also cause a broken bone. Therapy often consists of immobilizing the affected hand in a cast. If the carpal bones are more severely affected or the fracture is particularly complicated, surgery may also be necessary. In this way, long-term consequential damage such as wrist osteoarthritis should be avoided.

Read more on this topic at: Broken wrist

Other causes of pain in the back of the hand

Pain in the back of the hand can occur as part of many other diseases. But these not only cause back pain, but also other complaints. Here are some common causes of pain:

Joint, ligament and tendon injuries
Rheumatic diseases: group of very different diseases with the common feature that they lead to pain and functional disorders in the musculoskeletal system
Osteoarthritis: Degenerative disease in which the joints wear out
Arthritis: inflammation of the joints with different causes
Muscle injuries: ruptured muscle fibers, strains, sports injuries
Gout and attacks of gout: a metabolic disease in which uric acid crystals are deposited in joints
Osteoporosis: Disease of the skeletal system in which the bone density decreases, this leads to an increased tendency to fracture and pain
Circulatory disorders and thrombi
Ganglion: benign tumor formation that forms in the area of the joint capsules and superficial tendon sheaths and can sometimes be painful

Read more on the topic: Pain in the metacarpal boil

Concomitant symptoms

Which symptoms are associated with pain on the back of the hand depends heavily on the cause of the symptoms. In the event of an acute trauma such as a fall, the pain on the back of the hand can indicate injuries such as a bruise, sprain, or broken bone. The muscles and tendons that run down the back of the hand can also be affected. Usually there is also swelling, superficial bleeding and bruising are accompanying symptoms. If the cause of the pain is a degenerative or inflammatory disease, it is often not just one hand that is affected. The pain also occurs in the other hand or other joints.

swelling

The swelling is a symptom that is often associated with pain. Often this speaks for an inflammatory process. These include other symptoms such as reddening and overheating of the skin and limited mobility of the affected hand. The swelling in this case is usually caused by the body sending many inflammatory cells to the affected hand. These bring fluid with them, which escapes from the vessels into the tissue, is deposited there and thus causes swelling. Swelling can also occur with traumatic pain. This is due, for example, to bleeding from an injured vessel and thus leads to a bruise.

Duration

The duration of the pain on the back of the hand can vary from a few days to weeks. In chronic illnesses, the pain can last longer. How long the pain lasts depends heavily on its cause.Tendonitis, fractures / broken bones, etc. are usually healed after a few weeks when the affected hand is immobilized. Carpal arthrosis and rheumatic causes of the symptoms, on the other hand, are chronic and usually last a lifetime.

Examination and diagnosis in general

It is important to always have severe and persistent pain clarified by a doctor. The attending physician first asks about the exact location, type and intensity of the pain. Of particular interest is when and after which activities the pain occurs (e.g. at rest or typing on a keyboard).
During the physical examination, the entire arm is examined and examined for symptoms. The doctor uses various movement tests to check the functions of the hand.

Blood tests (e.g. for rheumatism), X-rays, ultrasound and MRT can also be included in the diagnosis. If joint damage is suspected, e.g. Arthroscopy can be performed as part of osteoarthritis. If there is a suspicion of nerve damage, e.g. When carpal tunnel syndrome is the case, various neurological tests are used. This includes measuring the nerve conduction velocity, strength and movement tests as well as vegetative function tests. Angiography can be performed if circulatory disorders are suspected.

Therapy of pain in the back of the hand

The therapy depends on the underlying cause. In most cases, however, it helps that immobilize and protect the affected hand. This can be achieved, for example, with splints or bandages. For pain relief one uses anti-inflammatory pain relievers like diclofenac and aspirinwhich can be purchased as ointments, tablets and creams. In rare cases, e.g. for very severe tendinitis, too Cortisone supplements and local narcotics used in therapy. Fractures and bottleneck syndromes such as carpal tunnel syndrome can be a surgery make necessary.
Generally it is recommended physiotherapy and physiotherapy exercises to strengthen the affected hand. It may also be advisable to strengthen your hands through strength training and sports that are gentle on the joints (e.g. swimming). This can have a positive effect on the pain.

Can a bandage help?

A bandage can relieve pain in the back of the hand. It is typically applied to tendinitis so that the muscles and tendons are supported in their function. Even after bone fractures, a bandage can be used when the hands are stressed. A bandage can also be worn for chronic diseases such as rheumatoid arthritis.

Pain in the back of the hand in the area of the thumb

The pain in the thumb can have various reasons. One cause of the pain in the back of the hand in the area of the thumb can be the wear and tear of the thumb saddle joint, known as rhizarthrosis. However, many patients also have pain in their thumbs that result from tension, excessive strain and incorrect hand posture during a wide variety of activities.

The SMS thumb is often used here - the constant typing and the unnatural movement of the thumb when using the cell phone for a long time causes pain. Pain in the back of the hand also occurs in the course of nervous irritation or bruises, such as in the case of carpal tunnel syndrome. Even with mild pain, a possible fracture of a small bone in the thumb or metacarpal should always be considered. The problems should be discussed with a doctor.

Tendonitis in the area of the thumb can also be the cause of the symptoms. Those affected often complain of pulling pains that get worse under stress.

Read more on the subject at:

Tendinitis in the thumb
Rhitzarthrosis

Pain in the back of the hand at night

Pain in the back of the hand may increase during the night. Many patients report of unbearable pain and numbness at night. This applies to diseases such as tendinitis, the carpal tunnel syndrome and also the repetitive strain injury syndrome. One reason may be that it is at night due to the lack of exercise increased pressure on the pinched nerve or the irritated and inflamed region comes. Another cause may be that the hand is unconsciously in a highly bent position at night, which increases pressure and increases pain.

Back hand pain during pregnancy

Many women complain of hand pain during pregnancy. The index and middle fingers are often affected. Tingling and numbness of the hand also occur. The reason is the increased hormone-related fluid storage in the tissue (edema during pregnancy). This edema can lead to carpal tunnel syndrome. The course of the median nerve is narrowed on the inside of the wrist.

Normally, there is no constriction, but the increased fluid in the tissue makes it too narrow in the passage between some ligament structures. Some women have no symptoms, others are very strong. The differences are also due to the fact that some women had problems or possibly even slight constrictions and changes in the area of the carpal tunnel before they became pregnant.

The pain often increases in the course of pregnancy and can persist after the birth and then slowly regress. This is because it takes a while for the stored fluid to break down again. During the day there is usually increased pain in the back of the hand at night and in the morning. This can be explained by the fact that during the night the hand is bent or held in some other unfavorable way, thus compressing the median nerve over a long period of time.

In addition, the lack of movement of the hand means that more water is stored in the tissue during the night. During the day, the water is regularly removed because you move your hands in everyday life. Women who gain weight during pregnancy often have more problems.

Regular finger exercises, a balanced diet, massages, acupuncture and homeopathic methods can be helpful in preventing pain. If, despite all therapeutic approaches and attempts to eliminate the symptoms, there is no improvement, an operation can also be carried out. This last measure should, if possible, not be exhausted during pregnancy, as the symptoms usually subside on their own a few days to weeks after delivery. If such symptoms occur during pregnancy, the attending physician should be contacted.

Read more on the subject at: Carpal tunnel syndrome in pregnancy

Pain in the back of the hand when bending

In general, when bending the hand, different structures can be used, such as Nerves, tendons, or vessels, compressed and cause pain in the back of the hand. A common cause of discomfort when bending the hand is in the Compression of the median nerve, one of the three large hand and arm nerves, on the inside of the wrist. At a existing inflammation this nerve comes to one through flexion increased constriction and exertion of pressure on him. this leads to uncomfortable pain in the back of the hand. This inflammation can be acute or chronic in nature.

Another reason may be the Degeneration or osteoarthritis of the wrist and the bones of the hands and their joints. When moving the wrist, such as bending over sharply, the worn joint surfaces rub against each other and cause pain for the person affected. Also Inflammation of the tendons (Tendonitis) and Irritation of the tendons (Tendinosis), as well as inflammation of the tendon sheaths (tendovaginitis) in the hand can cause pain in the back of the hand when bending. A so-called ganglion (Over legs) also cause pain in the back of the hand in many patients. These ganglions are often found on the back of the hand and can also pinch nerves and vessels. If the wrist is flexed too much, pressure and pain can occur.

Pain in the back of the hand from the computer mouse

Many secretaries and other people who work long and heavy computers can experience hand irritation. It is the "Repetitive Strain Injury Syndrome". The monotonous and repetitive movement irritates the wrist or the small joints in the metacarpus and leads to inflammation. Since the movement mostly does not only affect the hand, e.g. Elbow and shoulder joints can also be affected by the irritation and pain. Also affected are groups of people who carry out stereotypes, i.e. activities that are repeated over a long period of time, e.g. Assembly line workers or cashiers.

The therapy of choice in the short term is to protect and relieve the affected joint with a bandage. For the long-term process, it is important that the person concerned changes their work or activities in such a way that the complaints are no longer encouraged as far as possible.

When working on the PC, it is advisable to use a palm rest for the mouse and keyboard, as this makes the hand position more natural and ideally does not provoke any further irritation. In addition, breaks should be taken from the activity and exercises for the hands should be performed. A doctor should be contacted for more detailed diagnosis and treatment.

Read more on this topic at: Mouse arm

Hand anatomy

The hand is made up of bones, muscles, ligaments, tendons, nerves, and blood vessels.
It comprises 27 bones, of which eight carpal bones form the wrist. These eight bones lie in two rows and are connected to one another by joints. Part of the carpal bones is also connected to the radius. The wrist is connected to the five elongated metacarpal bones (Metacarpus), which are followed by the five fingers formed by 14 bones (2 for the thumb and 3 each for the other fingers).

The musculature of the hand is very complex and is largely formed by the forearm muscles, which then only send tendons into the hand. Some of these tendons can be felt from the outside and can be very painful in the event of inflammation or injury. The muscles of the ball of the thumb are called Thenar and the muscles of the little finger side Hypothenary.

The hand is supplied by three nerves and two major arteries. The nerves are called the median nerve, radial nerve and ulnar nerve. They are particularly important in the development of pain in compression syndromes such as carpal tunnel syndrome. The arteries that supply the hand are the radial arteries and ulnar arteries.

Figure back hand pain

Figure Pain on the back of the hand: causes (A-D) and therapy options (E-H)

Back hand pain

Extensor tendon of the back of the fingers -
Aponeurosis dorsalis digiti
Tendon connection
of the finger extender -
Intertendine connexus
Long thumb stretcher -
Extensor pollicis longus muscle
Finger extensor -
Extensor digitorum muscle
Extensor tendon strap -
Retinaculum musculorum
extensorum
Radial artery - Radial artery
Interbone muscle -
Interosseus muscle
Little finger extensor -
Extensor digiti minimi muscle
Ellen's nerve - Ulnar nerve
Median arm nerve - Median nerve
Spoke nerve - Radial nerve
Ulnar artery - Ulnar artery
Causes:
A - tendonitis
(Tendovaginitis)
B - carpal tunnel syndrome
(Compression syndrome)
C - Repetetive Strain Injury
Syndrome / RSI Syndrome
D - osteoarthritis or gout
Therapy of pain
E - rails
F - Stabilizing bandages
G - anti-inflammatory creams,
pain reliever as well
anti-inflammatory drugs
H - Physiotherapeutic and
physiotherapy exercises,
Weight training, joint-friendly
Sport (e.g. swimming)