Common Causes of Hand and Wrist Pain

Hand and wrist pain can develop after an injury or gradually from repetitive activity, arthritis, sports, work, weight training or age-related changes.

Because the hand and wrist contain numerous small bones, joints, tendons, ligaments and nerves, symptoms in the same general area can come from very different conditions.

Pain along the thumb side of the wrist may be associated with De Quervain's tenosynovitis, thumb arthritis or certain wrist injuries. Pain elsewhere in the wrist may involve tendons, ligaments, cartilage or one of the many small joints.

Numbness or tingling in the hand may indicate a nerve problem such as carpal tunnel syndrome rather than a joint or tendon condition.

Determining the structure responsible for the symptoms is an important first step before deciding on treatment.

Hand and Wrist Arthritis

Arthritis can affect many of the small joints throughout the hand and wrist.

Patients may experience pain, stiffness, swelling, loss of motion or difficulty gripping and performing everyday activities.

Osteoarthritis commonly affects the fingers and the base of the thumb, while previous injuries can contribute to arthritis in the wrist and other joints.

Treatment depends on which joint is affected, the severity of the arthritis and how much the symptoms interfere with daily activities.

Nonsurgical options may include activity modification, medications, bracing and selected image-guided injections.

Thumb Arthritis

Arthritis at the base of the thumb is a common cause of hand pain, particularly with gripping and pinching activities.

Patients may notice pain when opening jars, turning keys, using tools, writing or performing other activities that place stress across the thumb joint.

The condition can become progressively more symptomatic over time, but the presence of arthritis on an X-ray does not automatically mean surgery is necessary.

Depending on severity, treatment may include activity modification, bracing, medications, rehabilitation and selected image-guided procedures.

For appropriately selected patients, regenerative treatments such as PRP may also be discussed.

De Quervain's Tenosynovitis

De Quervain's tenosynovitis causes pain along the thumb side of the wrist where two thumb tendons travel through a small tendon compartment.

Symptoms may be aggravated by gripping, lifting, repetitive thumb movement or certain wrist motions.

Patients may notice tenderness and sometimes swelling near the base of the thumb.

Treatment can include activity modification, bracing, rehabilitation, medications and selected image-guided procedures.

Because several conditions can cause pain in this area, confirming that the symptoms actually originate from the involved tendons is important before treatment.

Trigger Finger

Trigger finger occurs when a finger tendon does not glide normally through its surrounding pulley system.

Patients may experience pain, stiffness, clicking or catching when bending and straightening the finger.

In some cases, the finger may temporarily become locked in a bent position.

Treatment depends on the severity and duration of the condition and may include activity modification, splinting and selected procedures.

Persistent or severe cases may require evaluation by a hand surgeon.

Wrist Tendonitis and Tendinopathy

Several tendons cross the wrist and can become painful from repetitive activity, sports, weight training or occupational use.

Patients may experience localized wrist pain that worsens with gripping, lifting or specific wrist movements.

Although these conditions are often described as “tendonitis,” persistent tendon problems may involve chronic changes within the tendon rather than simply inflammation.

Diagnostic musculoskeletal ultrasound can be useful because many wrist tendons can be directly visualized and examined dynamically as the patient moves the hand and wrist.

Treatment depends on the specific tendon involved and the severity of the problem.

Ganglion Cysts

Ganglion cysts are fluid-filled structures that commonly develop around the wrist or hand.

Some ganglion cysts cause no symptoms and require no treatment.

Others may produce pain, pressure, limitation of motion or discomfort during activities such as weight training, push-ups or wrist extension.

Because important tendons, nerves and blood vessels may be located near a cyst, determining its location and relationship to surrounding structures is important before considering a procedure.

Musculoskeletal ultrasound can help evaluate a suspected cyst and may also be used to guide aspiration when appropriate.

Ganglion cysts can recur after aspiration, so patients should understand the benefits and limitations of nonsurgical treatment.

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve becomes compressed as it travels through the wrist.

Patients may experience numbness, tingling, burning or discomfort involving the thumb, index finger, middle finger and part of the ring finger.

Symptoms frequently become more noticeable at night and may interfere with sleep.

As the condition progresses, some patients can develop weakness or difficulty gripping objects.

Treatment depends on the severity of the nerve compression and may include activity modification, nighttime bracing and other nonsurgical treatments.

Patients with significant weakness, muscle loss or severe nerve compression may require evaluation for surgical treatment.

Other Nerve Problems in the Hand and Wrist

Carpal tunnel syndrome is not the only nerve condition that can cause hand symptoms.

Nerves can become irritated or compressed at different locations throughout the arm, wrist and hand.

Symptoms may include numbness, tingling, burning pain, weakness or altered sensation.

In some cases, symptoms felt in the hand can even originate from a nerve problem at the elbow or cervical spine.

Determining where the nerve is being affected is important because treatment directed at the wrist will not solve symptoms that originate elsewhere.

Wrist Sprains and Ligament Injuries

A fall, sports injury or sudden twisting movement can injure the ligaments that stabilize the wrist.

Some wrist sprains recover with conservative treatment, while others may involve more significant ligament or cartilage injuries.

Persistent pain following a wrist injury deserves further evaluation, particularly when symptoms include clicking, instability, swelling or difficulty bearing weight through the hand.

Occasionally, what was initially assumed to be a simple wrist sprain may involve a more significant structural injury.

TFCC Injuries

The triangular fibrocartilage complex, or TFCC, is an important group of structures located along the small-finger side of the wrist.

TFCC injuries can occur following a fall, twisting injury, racquet sport or repetitive loading of the wrist.

Patients may experience pain along the ulnar side of the wrist, clicking or discomfort with gripping and rotation.

Some TFCC problems can be managed nonsurgically, while significant traumatic or unstable injuries may require evaluation by a hand or wrist surgeon.

The appropriate treatment depends on the type of injury, severity of symptoms and associated structural abnormalities.

Is Your Hand Pain Actually Coming From Your Neck?

Not every symptom felt in the hand originates from the hand or wrist.

Nerve irritation in the cervical spine can sometimes cause pain, numbness, tingling or weakness extending into the arm and hand.

Peripheral nerves can also become compressed at the elbow or elsewhere along the arm.

This is particularly important when hand symptoms are associated with neck pain, radiating arm pain or weakness.

A careful examination can help determine whether symptoms are coming from the hand, wrist, peripheral nerve or cervical spine.

Do You Need an MRI for Hand or Wrist Pain?

Not every patient with hand or wrist pain needs an MRI.

The appropriate imaging depends on the suspected diagnosis.

X-rays can be useful for evaluating arthritis, fractures and other bony abnormalities.

Diagnostic musculoskeletal ultrasound can evaluate many tendons, cysts, nerves and other superficial structures in real time.

MRI may be appropriate when a more complex ligament, cartilage or structural injury is suspected or when the diagnosis remains uncertain.

The goal is to select imaging based on the clinical question rather than automatically ordering an MRI for every painful wrist.

How We Diagnose Hand and Wrist Pain

Treatment begins by determining which structure is responsible for the symptoms.

An evaluation may include a review of how the pain began, previous injuries, sports and occupational activities, treatments already attempted and movements that reproduce the symptoms.

The physical examination can help distinguish between arthritis, tendon injuries, ligament problems, cysts and nerve conditions.

When appropriate, our physicians can use digital X-ray and diagnostic musculoskeletal ultrasound as part of the evaluation.

If an MRI, nerve study or consultation with a hand surgeon is necessary, we can recommend that as well.

Can Hand and Wrist Pain Be Treated Without Surgery?

Many common hand and wrist conditions can initially be treated nonsurgically.

Depending on the diagnosis, treatment may include activity modification, bracing or splinting, rehabilitation, medications and selected image-guided procedures.

For certain chronic tendon, ligament or arthritic conditions, PRP may also be considered in appropriately selected patients.

The appropriate treatment for thumb arthritis may be very different from treatment for carpal tunnel syndrome, a ganglion cyst or a TFCC injury.

That is why our approach begins with establishing the diagnosis rather than selecting a procedure before identifying the source of the symptoms.

PRP for Hand and Wrist Conditions

Platelet-rich plasma (PRP) is prepared from a patient's own blood and contains concentrated platelets and associated signaling proteins.

PRP may be considered for selected chronic tendon, ligament and arthritic conditions involving the hand and wrist.

Whether PRP is appropriate depends on the diagnosis, severity of the condition, previous treatments and individual patient factors.

It is not a substitute for surgical treatment when a significant structural injury or severe nerve compression requires surgery.

At Carolina Nonsurgical Orthopedics, regenerative treatment begins with determining whether the condition is one for which PRP is a reasonable nonsurgical option.

Why Image Guidance Matters for Hand and Wrist Procedures

The hand and wrist contain numerous small joints, tendons, nerves and blood vessels located within a compact area.

When an injection, aspiration or other procedure is performed, accurately identifying the intended target can be particularly important.

Musculoskeletal ultrasound allows the physician to visualize many of these structures in real time.

It can be useful for procedures involving small joints, tendons, cysts and other structures throughout the hand and wrist.

Ultrasound can also help identify nearby nerves and blood vessels when planning certain procedures.

At Carolina Nonsurgical Orthopedics, image guidance is an important component of many of the orthopedic procedures we perform.

What About Cortisone Injections?

Cortisone injections can have a role in treating certain hand and wrist conditions.

However, the decision to use cortisone depends on the diagnosis, location and individual patient.

A tendon problem, arthritic joint, nerve condition and ganglion cyst are fundamentally different problems and should not automatically receive the same treatment.

For patients with persistent symptoms, understanding the diagnosis and the available treatment options can help determine whether cortisone or another approach is most appropriate.

When Should You See a Hand or Wrist Specialist?

Consider an orthopedic evaluation when hand or wrist pain:

• Persists despite rest or activity modification

• Interferes with gripping or lifting

• Makes weight training or sports difficult

• Interferes with work or computer use

• Is associated with numbness or tingling

• Causes weakness or dropping objects

• Is associated with clicking or instability

• Began after an injury

• Continues despite previous treatment

• Limits normal daily activities

More urgent evaluation may be appropriate following significant trauma, obvious deformity, substantial weakness, loss of sensation or concern for infection.

When Is Hand or Wrist Surgery Necessary?

Many hand and wrist conditions can be treated without surgery, but nonsurgical care is not appropriate for every problem.

Certain fractures, unstable ligament injuries, complete tendon injuries, severe nerve compression and advanced joint problems may require surgical treatment.

Our focus on nonsurgical orthopedics does not mean avoiding surgery when it is clearly the better option.

The goal is to accurately identify the condition and determine whether reasonable nonsurgical treatments exist before an operation is pursued.

Staying Active With Hand and Wrist Pain

Hand and wrist problems can interfere with weight training, golf, tennis, pickleball, cycling and many other activities.

They can also make ordinary activities such as typing, opening containers, lifting objects and performing household tasks difficult.

Complete avoidance of activity is not always necessary.

Depending on the diagnosis, temporary modification of aggravating activities combined with appropriate treatment and rehabilitation may allow patients to remain active while the condition improves.

The objective is to identify the source of the problem and develop a plan that helps patients return to the activities that are important to them.

Hand & Wrist Pain Treatment in Raleigh & Cary, NC

Hand and wrist pain does not automatically mean you need surgery.

At Carolina Nonsurgical Orthopedics, our physicians evaluate arthritis, tendon problems, ganglion cysts, nerve conditions, sports injuries and other causes of hand and wrist pain.

Treatment may include bracing, rehabilitation recommendations, image-guided procedures, PRP and other nonsurgical options when appropriate.

If hand or wrist pain is interfering with work, exercise, sports or everyday activities, schedule an orthopedic evaluation at our Raleigh or Cary, NC location.