So THAT’S why your hands are hurting

From sausage fingers to knobbly knuckles, the causes of hand pain — and how to get a grip on it

HAND pain or lack of mobility affects thousands. While arthritis is the most common cause, scores of other conditions can cause discomfort. But how do you know which one is affecting you — and what can you do to tackle it? ROGER DOBSON reports . . .

LUMPS ON FINGERS

SYMPTOMS: Smooth, soft lumps under the skin around the joints of the fingers and wrist. These can sometimes be painful. PROBABLE CAUSE: Ganglion cysts — these swellings contain synovial fluid, the thick, jelly-like material that lubricates joints. They can form in response to damage, but in many cases the cause is unknown. TREATMENT: Most disappear over time, but if they are painful, the liquid can be removed with a needle under local anaesthetic or the cysts can be surgically removed.

SAUSAGE FINGERS

SYMPTOMS: Swelling and pain, accompanied by pitted or crumbly nails. PROBABLE CAUSE: Psoriatic arthritis, which is linked to skin condition psoriasis. Up to 600,000 people in Britain suffer from psoriasis, and one in five will suffer swollen hands. It often begins with a single finger being affected. The condition is caused by the immune system attacking the finger joints. TREATMENTS: Non-steroidal anti-inflammatory drugs such as ibuprofen may help, as can disease-modifying anti-rheumatic drugs (DMARDS) which reduce inflammation and slow progress of the disease.

COLOURED HANDS

SYMPTOMS: Cold weather or even touching something cold can change the colour of the fingers from white to blue, then red. This is accompanied by numbness, tingling, throbbing, and possibly pain and swelling. PROBABLE CAUSE: In chilly temperatures the blood vessels in the extremities, such as fingers and toes, narrow to prevent heat loss from the skin. However, in the condition Raynaud’s phenomenon, these are over-sensitive.

In some people they constrict to such an extent that blood flow is almost stopped, causing the fingers to turn blue. The blood vessels then dilate again, and the return of blood causes throbbing and pain.

It is thought to be a malfunction in the part of the nervous system that controls blood vessels — as many as one in nine women and one in 12 men is affected. There is evidence that it can be inherited.

In some cases, known as secondary Raynaud’s, the problem can be a symptom of an underlying condition, such as lupus or rheumatoid arthritis. TREATMENT: Lifestyle changes such as stopping smoking and boosting exercise can improve circulation. Stress can exacerbate the condition, as it causes the release of the hormone adrenaline which can narrow blood vessels.

A group of drugs called calcium channel blockers can help by widening blood vessels. Surgery to cut the nerves responsible may be used in severe cases. Rarely, a finger may have to be amputated if the blood supply has been blocked and gangrene has set in.

KNOBBLY JOINTS

SYMPTOMS: Finger joints and knuckles are painful and tender; the top joints of the fingers develop knobbly swellings. PROBABLE CAUSE: Osteoarthritis — more than 12 per cent of people over the age of 50 suffer from severely disabled hands due to the condition, according to a study at Keele University.

It’s caused by wear and tear of the cartilage, the tissue that cushions the bones in the joint. The base of the thumb and joints at the ends of the fingers are usually affected, possibly because they receive the greatest stresses and strains on a daily basis.

‘Osteoarthritis of the hand is considered to be less disabling than hip or knee osteoarthritis, but a large proportion of people affected report they have significant difficulties with everyday tasks,’ says Philip Conaghan, professor of musculoskeletal medicine at the University of Leeds. ‘This has a great impact on their quality of life.’ TREATMENT: While painkillers are the first port of call — paracetamol or paracetamol with codeine — antiinflammatory painkillers such as ibuprofen can help by reducing swelling. Another option is a prescription non- steroidal antiinflammatory such as diclofenac or celecoxib. In severe cases, surgery may be offered. The most common procedure is a trapeziectomy, where the thumb joint is removed and replaced with an artificial one.

Knuckles can also be replaced, while finger joints can be fused, though this can lead to a loss of flexibility.

WEAK GRIP

SYMPTOMS: Pain and muscle cramps in the thumb, fingers or wrist during activities that require fine movements. There may be uncontrollable and excessive gripping. PROBABLE CAUSE: Focal dystonia of the hand, also known as writer’s cramp, triggers involuntary muscle contractions and leads to slow repetitive movements or abnormal postures. ‘Task-specific’ dystonias, which mainly affect the hands, usually occur during a repetitive activity such as sewing.

Up to 100,000 people in Britain are affected, but doctors are unsure of the cause — one theory is that it’s connected to an abnormality in the basal ganglia, the region of the brain that controls movement and coordination. TREATMENT: Muscle- relaxing drugs can help, as can Botox. Physiotherapy can be used to ‘re-train’ muscles. In severe cases, patients may undergo surgery to sever the nerves to the problem muscles, stopping the spasms.

CREAKING HANDS

SYMPTOMS: Stiff and swollen joints, accompanied by tingling, pain and a creaking sound during movement. The space between the fingers and thumb may also widen. PROBABLE CAUSE: Rheumatoid arthritis, a condition that affects 400,000 in Britain. This is caused when the body’s immune system starts to attack joints. The creaking is due to worn cartilage or loss of synovial lubricating fluid. TREATMENT: Splints to immobilise the joint; painkillers and antiinflammatory drugs; DMARDS such as methotrexate — these help to dampen the inflammation and pain. Joint replacement surgery may be necessary as the condition is progressive and can lead to joints eroding over time.

CLAW HAND

SYMPTOMS: Painful lumps on the palm of the hand, thickening of the skin in the palm and the inability to straighten one or more fingers. PROBABLE CAUSE: Dupuytren’s contracture. This condition, which causes the tissue in the palm to thicken and pull on the fingers, affects two million people in Britain. The cause is unknown; it tends to affect more men than women, and is more common in the over-50s. TREATMENTS: Most cases are mild, but surgery may be needed to cut or remove connective tissue. A new treatment involves injections of collagenase clostridium histolyticum, a drug that contains bacterial proteins, which break up the connective tissue.

ITCHY FINGERS

SYMPTOMS: The skin is dry and cracked, with tiny itchy blisters. PROBABLE CAUSE: Eczema, also known as hand dermatitis. This is a non-contagious condition where contact with allergens such as soap or detergents irritates the skin. A specific type, pompholyx, occurs more often in women, and triggers small, itchy blisters on the palms. The exact cause is not known, but there may be a genetic link. TREATMENT: Fragrance- free moisturising creams may help, and corticosteroid creams — over the counter or on prescription — can rapidly reduce inflammation.

TINGLING PALMS

SYMPTOMS: Burning, itching, tingling or numbness in the palm and the fingers, especially the thumb, index and middle fingers. Symptoms appear in one or both hands during the night, and this develops into tingling during the day. Grip may weaken, and there may be piercing pain that shoots through the wrist and arm in certain positions. PROBABLE CAUSE: These are characteristic symptoms of carpal tunnel syndrome. The carpal tunnel is a channel that runs between the wrist and hand, carrying tendons and a nerve — repetitive movement of the wrist during activities such as typing, sewing and gardening can lead to these soft tissues being compressed on the thumb side of the hand. TREATMENT: Wrist exercises, such as making tight fists and then relaxing them, can help. Over-thecounter painkillers such as aspirin and ibuprofen can help ease symptoms of pain and inflammation.

Doctors can prescribe diuretic drugs — tablets or injections — to reduce swelling of tissue, or corticosteroids to tackle inflammation. In extreme cases, surgery to trim tissue in the wrist can reduce pressure on the nerves. However, there is a small risk that symptoms will return after the procedure.

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