Joint pain in the hands is a common complaint that can significantly impact daily activities and quality of life. The hands have many small joints and are constantly in use, making them prone to pain and injury. Understanding the various causes of hand joint pain can help guide effective treatment.
Causes Of Joint Pain In The Hands
The most common causes of joint pain in the hands include:
Osteoarthritis
Osteoarthritis is a degenerative joint condition caused by the progressive breakdown of cartilage in the joints. It is the most common form of arthritis and frequently affects the joints of the fingers, thumbs, and wrists. Risk factors include older age, family history, previous joint injury, and repetitive hand use.
As the cartilage wears down, symptoms include joint stiffness, swelling, pain, and reduced range of motion. Osteoarthritis in the hands typically starts at the base of the thumbs and the ends of the fingers closest to the fingernails. It can eventually cause bony growths called Heberden’s and Bouchard’s nodes on the finger joints.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. It occurs when the immune system mistakenly attacks the joints, causing pain, swelling, and eventual joint damage. RA commonly affects the wrists and finger joints in a symmetric pattern, though any joint may be involved. Symptoms often include morning stiffness lasting over 30 minutes and fatigue. RA in the hands can cause deformities over time.
Post-Traumatic Arthritis
Previous significant joint injuries, such as fractures, dislocations, and ligament tears, can increase the risk of developing post-traumatic arthritis. It occurs due to damage to the cartilage and bones within the joint, causing irregular joint surfaces that lead to abnormal wear patterns.
Activities that place repetitive stress on the injured joint can hasten the progression of post-traumatic arthritis. The base of the thumb is particularly prone to post-traumatic arthritis due to its frequent use.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused by compression of the median nerve as it passes through the wrist into the hand. It leads to numbness, tingling, weakness, and pain in the thumb, index, middle finger, and radial half of the ring finger. Symptoms are typically worse at night. The carpal tunnel is associated with repetitive hand tasks, obesity, diabetes, hypothyroidism, and pregnancy.
Trigger Finger
Trigger finger, also called stenosing tenosynovitis, results when a tendon passing through the sheath to the fingers gets inflamed and swollen. This causes it to catch as the finger is bent and straightened. It classically causes pain, catching, locking, and a popping sensation. Any finger can be affected, though it most often involves the thumb and ring fingers. Diabetes, rheumatoid arthritis, and repetitive gripping actions can contribute to the trigger finger.
Gout
Gout results from the accumulation of uric acid crystals within the joints, leading to inflammation and abrupt onset of red, hot, swollen, extremely painful joints. While gout most often first attacks the big toe, it can also affect the joints of the fingers, wrists, and elbows. Frequent episodes can eventually cause joint damage. Risk factors for gout include diet, genetics, excess weight, and certain medications.
Heberden’s Nodes
Heberden’s nodes are bony enlargements that develop on the distal finger joints farthest from the fingernails, especially the index and little fingers. They are a hallmark of osteoarthritis. The nodes may be enlarged on just one or several fingers. Although not directly painful, they can limit finger mobility.
Swollen Knuckle
A swollen knuckle may have many causes including injury, infection, osteoarthritis, gout, and rheumatoid arthritis. The swelling results from fluid buildup and inflammation within the joint. Evaluation by a doctor can help determine the specific cause.
Pyogenic Flexor Tenosynovitis
Also known as a trigger finger infection, this condition involves an infection of the tendon sheath in the finger or thumb. It causes acute swelling, redness, and throbbing pain in the affected finger, with difficulty bending. It often occurs due to puncture wounds or skin infections of the hand spreading to the tendon sheath. Diabetes and immune deficiency increase risk. Antibiotics and sometimes surgical drainage are needed.
Psoriatic Arthritis
Psoriatic arthritis is a type of inflammatory arthritis associated with the skin condition psoriasis. Between 10-30% of people with psoriasis develop psoriatic arthritis. It can cause swelling, pain, and eventual joint damage. The distal joints of the fingers are most frequently affected, taking on a sausage-like appearance. Nail changes like pitting are also common.
Raynaud’s Phenomenon
Raynaud’s phenomenon causes fingers to become abnormally cold, numb, tingly, and painful in response to cold exposure or stress. It results from blood vessel spasms that decrease circulation to the area. The skin may take on a pale or bluish color. Symptoms reverse as circulation returns. Primary Raynaud’s has no known cause, while secondary Raynaud’s occurs due to an underlying disease.
Dupuytren’s Contracture
This condition involves abnormal thickening and contracture of the fibrous tissue beneath the palm skin overlying the fingers. It causes the fingers, often the ring and little finger, to bend down toward the palm and become fixed in this flexed position, impairing hand function. Risk factors include older age, diabetes, smoking, and alcohol use. Genetics and Northern European ancestry also increase risk.
Infectious Arthritis
Various bacteria, viruses, and fungi can sometimes infect the joints, producing inflammation, pain, and swelling. Infectious agents that can infect the finger joints include gonorrhea, hepatitis, parvovirus, echovirus, rubella, and various fungi. Symptoms often come on rapidly and joints may appear red and warm. Blood tests, joint fluid cultures, or other testing can identify the organism.
Lupus
Systemic lupus erythematosus is an autoimmune disease that can cause joint pain and swelling in the hands. Lupus often first appears in the hand joints and then spreads to other joints over time. Joint swelling may worsen with sun exposure. Rashes, fatigue, and kidney problems can also occur. Blood tests help diagnose lupus.
Reiter’s Syndrome
Also called reactive arthritis, Reiter’s syndrome causes joint inflammation following certain bacterial infections. The classic triad also includes urethritis and conjunctivitis. The joints of the fingers and toes are often involved, appearing swollen and red. Treatment involves managing symptoms and treating the underlying infection if identified.
Conclusion
In conclusion, many conditions can contribute to joint pain in the hands, especially osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and overuse injuries like carpal tunnel syndrome. Careful evaluation of symptoms, timing, joint involvement, medical history, and risk factors can aid in diagnosis.
Treatments vary based on the specific cause but may include rest, splinting, analgesics, anti-inflammatories, surgery, and medications to slow disease progression. Prompt diagnosis and management can help to reduce pain and maintain optimal hand function.
