Neurological (nerve) problems
Hand or wrist pain can be due to problems with a nerve to the area.
Carpal tunnel is a well known example which causes pins and needles or pain (often at night), and wasting of the muscle around the base of the thumb with weakness on some thumb movements.
Carpal tunnel is due to
median nerve irritation e.g. from tight wrist tissues, scar tissue, oedema (swelling), such as during pregnancy, or from upper back vertebral problems. There are also some diseases which cause it.
Whilst surgical decompression may be needed for the worst cases, in many others it disappears with osteopathic treatment.
Other nerve problems
Not all hand symptoms are due to problems in the hand or wrist. Cab drivers, for example, who might spend hours with their elbows resting on the driver’s window sill, may compress & irritate the
ulnar nerve under the elbow - this is the location of the pain most of us have experience when banging the ‘funny-bone’ !
Similarly, cyclists can also experience the same ulnar nerve irritation, but this time in the hand itself due to continuous compression against the handle bars. A different compressed nerve, this time the
radial nerve coming out of the lower neck can result in weakness of the muscles running down the back of your forearm, leading to a reduced ability to bend the hand back.
On your first visit we will identify which nerve is affected and where it is being irritated.
Trauma
A fall on the outstretched arm and hand is a common source of fracture of a bone under your thumb (the scaphoid). Pain in this area should always be investigated with x ray as a fracture can leave a bony fragment of the scaphoid without blood supply, leading to necrosis (death!) of the fragment and further complications.
Poor Mechanics
Poor mechanics & abnormal restricted movement of the small bones of the wrist area and the two long bones of the lower arm (radius & ulnar) create problems that seem to come about for no obvious reason. In such cases, an x-ray or MRI may show nothing despite the pain. The patient may still be getting pain despite following advice to do various hand exercises or wear a splint.
Subtle restrictions in these joints won’t be observable with imaging, but can cause continued pain if they are not treated.
Arthritic changes
These are more likely causes of hand pain in older patients, but the onset of arthritis can be brought forward by trauma or repetitive long term use of heavy hand held tools such as hammers. As elsewhere in the body, such as the lower back, patients will often find that although we can’t get rid of the wear and tear, they can be a lot more comfortable and enjoy more mobility with treatment.
As with most musculo-skeletal conditions, there are causes of hand & wrist pain which are linked to diseases rather than to local problems. Diabetes, gout, bone tumours, rheumatoid arthritis & thyroid problems can also be responsible. These need considering as potential contenders in the diagnostic process.
