Understand and Overcome Hand and Wrist Pain
- LMN
- Jun 20, 2018
- 15 min read
Updated: Jun 21, 2018
Whatever your hand finds to do, do it with all your might. But what if your hand (or wrist) is always in pain or doesn't function fully?
Like feet, we use our hands everyday yet they are one of the most unthought of or neglected parts of our bodies.
Having done a post on feet, a part of our body that bears the burden of our activity here on earth, I began to ponder on what I should write about next. The answer came swiftly and forcibly as I became incapacitated in my left hand literally overnight.
Although I am right-handed, I began to appreciate the extent to which I use and need my left hand for everyday taken-for-granted activities such as showering, lifting, dressing, typing, walking and sleeping.
We assume that we will always have access to fully working hands and feet but there are many of us who live with pain in both our hands and feet with no idea how to cure that pain.
As usual, the recipe for resolution for me was God, Google and girlfriends. I got my mother and sister to pray with me for healing and I set about to research what was wrong, why it was wrong and how to remedy that wrong.
Musculoskeletal disorders (MSDs) is a Common Source of Hand/Wrist Pain
We can begin our analysis by identifying the type of disorder.
Musculoskeletal disorders or MSDs are those injuries or pain in the our musculoskeletal system, which involves our muscles, joints, nerves, discs, blood vessels, ligaments and tendons. Essentially, these disorders limit our movement and productivity as well as the quality of everyday life since they cause pain and damage in those areas (muscles, tendons, joints) that allow and facilitate movement. They also increase as we get older.
According to the US Bureau of Labor Statistics , MSDs in 2016 was one of the leading non-fatal occupational Injury/illness that caused workers to be unable to work.
The table below indicates just how many iterations of MSDs affect persons. We can experience MSDs in our heads, necks, trunks, upper and lower bodies.
We can suffer from pain in multiple areas in our upper or lower body and in multiple locations along our arms, hands and in fact in multiple body parts. If we understand that our muscles and nerves, joints and tendons are inter-connected and are located all over the body, then we can begin to appreciate the complexity and multi-faceted nature of MSDs. Sufferers of MSDs can have pain from their shoulders to their elbows, in their fingers, from their wrists to their finger, in their back and their knees depending on which muscle, ligament, tendon or nerve is being affected.
Within the private work sector, MSDs of the trunk (chest, back, abdomen and pelvic area) were the most common followed by MSDs in the upper extremities (shoulder, arms, wrists and hands). And what is interesting is that within the category of MSDs in the upper extremities the incidence rate of wrist injuries s second only to that of MSDs in the shoulder. Considering that most of the work we do employs our hands, the rate of wrist and hand injuries or disorders is significant.
Wrist pain is one of the most common MSDs suffered by workers.
Repetitive actions can tighten our nerves over time, cause nerves to be out of alignment which then lead to nerves being compressed or entrapped. Ligaments and bones can also be worn down as joints and muscles function on an ongoing basis out of balance and out of position.
Causes of MSDs
We increase the risk of developing an MSD if we are exposed to
certain work or ergonomic risk factors which include:
Forceful exertion
Sustained awkward postures
Repetitive tasks
All of these risk factors place our musculoskeletal system (nerves, joints, muscles and tendons around the affected joints) under excessive pressure. It is continually being forced to perform under less than optimal pressure whether from increased muscle effort in response to high force requirements or repetitive or sustained awkward positions and all usually with no time to recover and rebuild. This build up of pressure will eventually cause parts of our musculoskeletal system to deteriorate or wear down and this leads to pain and even non-functioning in the specific area.
We also increase our exposure to MSDs through individual factors:
Poor health for example drinking, smoking and obesity
Poor eating and hydration habits
Poor sleeping habits (It’s all connected - see my post on the sleep crisis and its impact on our bodies)
Poor work habits and practices for example lifting techniques and body positions
Falls and aging
These factors increase fatigue and compromise the ability of musculoskeletal system to recover and rebuild from continual over-exertion or even from normal exertion.
Types of MSDs
Common MSDs include:
Carpal Tunnel Syndrome
Epicondylitis
Tendonitis
Degenerative Disc Disease
Ligament Sprain
Ruptured / Herniated Disc
DeQuervain’s Syndrome
Mechanical Back Syndrome
Thoracic Outlet Compression
Rotator Cuff Tendonitis
Muscle / Tendon strain Radial Tunnel Syndrome
Digital Neuritis
Trigger Finger / Thumb
Tension Neck Syndrome
MSDs in the hands and wrists
As can be seen from Table I of the various locations of MSDs, we can analyze the musculoskeletal disorder according to the location in our musculoskeletal system. Having ascertained the location, we can then seek to determine the action or activity that may have caused that pain and then, based on the particular nerve, muscle, tendon or ligament, source and execute the particular treatment (including in some cases, avoidance) that will eliminate the pain.
I thought that I would focus more on MSDs that are caused by repetitive tasks or what is commonly called repetitive-strain injuries (RSIs) in the hand and wrists since most of us are daily computer or cellphone users and well, because the ailment that I had was an RSI.
Hand and wrist disorders present in several forms, have several different causes and require various treatments. Our focus in terms of treatment will be on non-surgical treatments and more so on treatments that we can do ourselves. Please remember that all the treatments discussed are simply suggestions, not based on my medical expertise just internet research and you should see a doctor especially if the symptoms worsen or do not improve.
On average, we can make 50,000–200,000 keystrokes a day while working at our computers.
On average, we can make 50,000–200,000 keystrokes a day while working at our computers. Should we be surprised then by the wear and tear that can result from such repetitive action? These high volume repetitive actions cause MDSs and more specifically RSIs. There are several tasks that include repetitive action and cause hand and wrist pain. And these actions are not extraordinary ones but are quite ordinary tasks that we perform everyday and from day to day.
Typing
Playing a musical instrument
Writing
Carpentry
Knitting and crocheting
Mechanic work
Dentistry
Weight lifting
Cycling and biking
Hairdressing
Repetitive actions can tighten our nerves over time, cause nerves to be out of alignment which then lead to nerves being compressed or entrapped. Ligaments and bones can also be worn down as joints and muscles function, on an ongoing basis, out of position and out of balance.
Musculoskeletal disorders (MSDs) of the Hand/Wrist:
Symptoms, Causes and Treatments
Analysis of pain in the hand and wrist can be further narrowed down to the nerve or muscle that is damaged or causing the pain.
Since we are talking about hand and wrist pain, our discussion will be restricted to the median and ulnar nerve which like all nerves provide sensation and strength to muscles. Both nerves start in the neck as a branch from the spinal cord, and then head down the arm but along different paths to the wrist and hand.
There are several hand and wrist disorders and RSIs and many more median and ulnar-sided issues other than what is mentioned here - issues that affect the neck, shoulder, elbow and arm. The examples given are just a very small sample of the disorders that can occur. In fact, the research that I did mentioned that it is sometimes quite difficult to diagnose the cause of issues because of the many parts of the wrist and the hand.
Median Nerve Compression or Entrapment Disorders
The Median nerve provides feeling to the index, middle finger and the thumb side of the middle finger, and supports muscle function to bend the thumb and other fingers. The median nerve starts in the neck travels along the front of the arm and into the palm.
Carpal Tunnel Syndrome (CTS)
We hear a lot nowadays about Carpel Tunnel Syndrome (CTS) and that’s because it is the leading nerve disorder that causes pain in the upper extremities and in particular the hand and wrist. More than 8 million Americans suffer from CTS.
Causes of CTS:
Feeling in the palm, thumb, middle and index finger and the thumb side of the ringer finger is provided by the median nerve.
When the median nerve which passes through the carpal tunnel (in the wrist) is compressed (squeezed or pressed) or entrapped, pain and compromise of function may occur.
Women tend to be more prone to carpal tunnel syndrome because of risk factors, such as pregnancy.
Other risk factors for CTS include
diabetes
cysts that encroach on carpal tunnel passageway
drinking alcohol
being overweight
thyroid disease
arthritis.
Symptoms of CTS:
These may include but are not limited to:
Numbness, burning or tingling in the thumb, middle and index finger or/and the thumb side of the ringer fingers especially during the night
Being awakened by your hand falling asleep
Nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand.
Pain in the palm and thumb, middle and index finger and the thumb side of the ringer finger, in the wrist or/and the forearm
Eventually, functions such as holding objects or driving may be compromised
Treatments for CTS:
The main treatment is avoidance of activities that create the symptoms. Several home remedy treatments are the same as detailed near the end of this article for computer use and repetitive tasks. Treatment may also include:
Avoiding activities that worsen symptoms
Taking breaks during repetitive tasks
Relaxing your grip for example in writing or typing
Stretching or elevating your hand
Applying cold packs to reduce swelling
Wrist splinting for mild to moderate symptoms; This can be done during the night and daytime.
Resting your hand
De Quervain's Tendinitis or tendinosis or tenosynovitis:
Another Thumb-sided Disorder like CTS
I thought of including this particular disorder because it is common. Whilst it is not a median or ulnar nerve entrapment disorder, it does affect the thumb side of the wrist like CTS.
De Quervain's Tendinitis is another common thumb-sided disorder due to inflammation of the tendons that run from the wrist into the thumb.
Tendons are like ropes used by muscle to pull the bone and under normal conditions, they glide smoothly through a sheath-like tunnel. De Quervain's Tendinitis occurs when the two tendons that run from the back of the thumb down to the wrist swell following irritation (perhaps as a result of repetitive actions such as gripping, clenching or wringing) and as a result do not slide smoothly through the sheath or small tunnel.
Causes of De Quervain's Tendinitis :
This disorder is caused by inflammation of the tendons at the base of the thumb side of the wrist. This inflammation can in turn be caused by:
Injury to the wrist
Rheumatoid arthritis
Chronic overuse of your wrist, lifting something that uses the thumb as leverage like a baby
Changes in hormones eg. after child delivery
Symptoms of De Quervain's Tendinitis:
Pain that develops gradually or it may start suddenly
Pain, numbness or/and swelling on the thumb side of the wrist
Pain upon turning your wrist, pinching, grasping or making a fist
Stiffness or sticking sensation when moving your thumb
Repetitive actions exacerbate the pain
Treatments for De Quervain's Tendinitis:
Rest your wrist by using a splint for example
Use a wrist splint during any activity that could cause stress eg. sports
Apply cold (for example ice wrapped in cloth) to your wrist every hour for 20 minutes while awake
When you regain some movement without pain, commence some light stretching exercises to strengthen wrist. Do a search on YouTube for samples of exercises.
Medline Plus recommends that you do the following before and after any activity:
Apply a heating pad to the wrist
Loosen the muscles by massaging the wrist and thumb
Apply cold to your wrist and take pain medicine after activity if there is pain
Ulnar-sided Compression or Entrapment disorders
Ulnar-sided disorders occur as a result to the ulnar nerve being compromised for some reason.
So what is the ulnar nerve? It is a nerve that starts in the neck, runs through the shoulder and armpit, down the arm and into the wrist where it travels through the Guyon Canal, and branches into the hand and fingers.
What is the ulnar nerve good for? It gives feeling to your forearm, the pinkie finger and your ring finger (on the ulnar side). And it also allows the hand to bend and to move to perform fine dexterity tasks such as writing and gripping.
The ulnar nerve is located on the “pinkie” side of the wrist and so injuries or disorders on that side of the wrist are called ulnar-sided.
Examples of causes of ulnar-sided disorders:
As I mentioned before, there are several causes of disorders of the hand and wrist. Since the nerve runs through the neck, shoulder, arm, wrist and hand, you can imagine the various iterations of disorders that can occur anywhere along those locations and as a result of so many causes.
Some examples of causes include but are not limited to:
Fractures
Arthritis
Ulnar nerve compression or entrapment
Tumors (usually benign)
Triangular Fibrocartilage Complex Injury (TFCC) (when the connection between the ulna bone and other structures in the wrist is torn by an injury or frayed over time)
Ulnar impaction syndrome (when the ulna is longer than the radius, which can cause it to “bump into” the smaller wrist bones
I want to focus on ulnar nerve compression or entrapment disorders (in particular those caused by repetitive actions) and of course, we cannot cover all the disorders.
Causes of ulnar nerve compression or entrapment:
Ulnar nerve compression or entrapment is caused when the ulnar nerve becomes compressed (squeezed) or pressured for whatever reason. If left untreated, ulnar nerve compression or entrapment can lead to permanent damage. However with appropriate and timely treatment, it can be cured.
Symptoms of ulnar nerve compression or entrapment:
General Symptoms can include but are not limited to:
Pain or/and numbness on the “pinkie” side of wrist with or without movement
Numbness in the little finger and in the ulnar side of the ring finger
Clicking or popping, especially with rotation
Decreased grip strength
Decreased or limited motion
Treatments for ulnar nerve compression or entrapment:
Treatment of ulnar-sided wrist injuries or pain is based on the diagnosis but may include
Wearing a splint
Resting the hand and wrist
Stopping the activity that caused the injury/pain
Sleep or/and work modification
Massaging the area
Examples of Ulnar-sided RSIs:
Ulnar Tunnel Syndrome or Guyon’s Canal Syndrome
Ulnar nerve entrapment typically occurs at two points, the cubital tunnel and Guyon’s canal.
Guyon’s canal syndrome, also known as ulnar tunnel syndrome, occurs less frequently than cubital tunnel syndrome.
The flip side of Carpel Tunnel Syndrome is Guyon's canal syndrome which involves entrapment of the ulnar nerve instead of the median nerve. The entrapment or constriction of the ulnar nerve in Ulnar Tunnel Syndrome or Guyon’s canal syndrome occurs at the point that the nerve passes through the Guyon's canal in the wrist.
Carpel Tunnel Syndrome and Guyon's canal syndrome may occur in the same hand.
Causes of Guyon’s canal syndrome
Any activity or action or condition that causes pressure on or irritates the ulnar nerve resulting in swelling or thickening of the nerve which is then constricted or squeezed within the Guyon canal may lead to Guyon’s canal syndrome. These may include but are not limited to
Benign tumors or cysts called ganglions
Repetitive wrist and hand actions such as using a jackhammer
Chronic pressure on the palms from activities such as riding a bicycle (pressure on handlebars), operating a jackhammer, using crutches and weight lifting
Chronic overuse of the wrist from heavy gripping, twisting
Working with the hand bent down and outward can squeeze the nerve inside Guyon's canal
Arthritis or traumatic injury
Symptoms of Guyon’s canal syndrome
Guyon’s canal syndrome and Carpel Tunnel Syndrome may both present with numbness but in different locations. Median nerve compression in CTS will present with numbness and pain in the thumb, middle and index finger or/and the thumb side of the ringer fingers especially during the night whilst compression of the ulnar nerve in Guyon’s canal syndrome will usually present with numbness in the pinky and the ulnar (pinkie finger) side of the ring finger.
In general, Guyon’s canal syndrome results in
Tingling in the little finger and along the ‘pinkie finger side’ of the ring finger usually after awakening that progresses into burning pain in wrist and hand
Numbness in the little finger and the ‘pinkie finger side’ of the ring finger
Decreased grip and pinching strength
Decreased or limited hand motion
Treatments for Guyon’s canal syndrome
How you resolve this depends on the cause of the pressure or compression of the nerve but primarily involves activity modification.
Changing the way you position your wrist to avoid pressure on the ulnar nerve for example while typing or holding your phone. In my case when I hold my phone while on the computer, I tend to rest my wrist on the edge of the table or desk. That is a no no since it can place great pressure on the nerve
Add padding to reduce pressure eg. on bike handles
Changing jobs or change techniques in using equipment like jackhammers
Changing hand position while riding
Changing hand position while sleeping to avoid curling the hand or sleeping on your wrist and thus pressing on the ulnar nerve
In treating my ulnar tunnel syndrome, I found this very practical video with exercises that really helped.
Cubital-tunnel syndrome
Cubital-tunnel syndrome involves compression or entrapment of the ulnar nerve but on the inside of the elbow. We sometimes call this nerve the “funny bone” nerve.
Causes of Cubital-tunnel syndrome:
Continual/repetitive bending of your elbow can stretch the nerve. Activities than can cause this occur eg. during sleep, doing a task or holding a phone
Direct pressure on the nerve like resting your elbow on a hard surface. Eg. when you are using a keyboard/typing or sitting in a chair with arms. Since there is little padding around the nerve, such pressure can cause the arm, fingers or hand to ‘fall asleep’
If for some reason the nerve does not stay in place but moves back and forth over a bony bump as we move our elbows, the nerve can become irritated, swell or thicken and then malfunction
Symptoms of Cubital-tunnel syndrome:
Symptoms can include:
Pain in the forearm
Numbness or tingling along the inside of your arm
Numbness or tingling in the ring and little finger
Weakness in the hand and fingers
Difficulty while attempting hand movement
Compromised gripping capacity (leading to dropping things)
Weakness while pinching
Loss of bulk and strength in the muscles in the hand
Treatments for Cubital-tunnel syndrome:
Non-surgical treatment consists mainly of avoidance. Detect the actions causing the syndrome and stop them.
Pad the elbow wearing over the ulnar nerve and “funny bone”eg. with a towel
Keep the elbow from bending while sleeping by wearing a splint
Avoid resting on the elbow
Summary of Treatments for Hand and Wrist RSIs
Treatment of hand and wrist pain from repetitive action (RSIs) falls generally into a consistent approach:
Identify the offending activity
Stop or reduce it
Relieve the nerve
Strengthen the muscle
In my case, I experienced numbness on the ulnar side of the wrist in my little finger and on the side of my ring finger. The numbness wore off on the first day and I forgot all about it until I awoke with the same numbness on the second and third day. However, the numbness progressed to excruciating pain one morning to the extent that I could not move my wrist to shower, dress, put on makeup or do anything with my left hand!
Whilst there was no detectable (at least not by me) swelling in my hand or wrist, the area of the wrist where it connects to the hand (on the little finger side) and just by that bump was very tender to the touch. I didn't use my left hand for about two days.
Symptoms of ulnar-sided entrapment fitted mine and I began to scan my prior activities for injuries. Since there was no black and blue area and since I could not remember any incident of falling or hitting my hand, I then focused on positioning and activities. Though it seemed as if the symptoms had started suddenly, I realized that they actually began when I awoke so I reviewed my sleep positions and implemented some changes which included:
Sleeping with my hand stretched out on a pillow instead of under my head
Holding my phone with a straight hand as opposed to bending my hand perpendicular to the wrist thus avoiding pressure on the ulnar nerve
Not resting my wrist on the edge of the table/desk as I used to when holding my phone
Massaging the area with organic coconut oil
Doing the ulnar-sided stretches here: Great exercises for ulnar nerve
The pain and numbness disappeared after the first night and day of implementation. I guess that more serious cases would take longer to be remedied. But it was definitely a frightening experience and I was planning that if the symptoms did not go in a week, I would visit the doctor.
The experience made me very aware that our habits of days and years may take their toll on us on this side of 50. I had slept with my arm under my head for years with no apparent repercussions. Literally overnight, debilitating wrist pain had rendered my hand useless.
Forewarned is forearmed - I have begun to undertake additional preventative measures like sleeping on my back (that will take some doing!), not crossing my legs and not pressing down my elbows or forearms too heavily on my desk or chair.
Prevention is Better than Cure
Whilst no prevention is 100% guaranteed, we can seek to minimize our risks of developing MSDs by some changes in our lifestyle which also in most cases has some helpful side effects in other areas.
Some general prevention measures:
Building bone strength which can help prevent fractures.
Wearing proper shoes
Removing any obstacles in your living space
Installing adequate lighting
Having assistive devices light grab bars in the bathroom
Wearing protective gear for sports - wrist bands.
Prevention regarding Computer Use:
We are all computer users. Years of computer use with all the repetitive actions can result in compression and wear and tear on the finer bones, nerves, muscles and nerves in the wrist and the hand. There are however some general practices that we can adopt as prevention or as treatment of ailments.
UCLA Ergonomics has some really good tips for computer use. I have tried to list a few interesting ones here (some of which I didn't know about before).
1. Adopt good typing techniques like:
Not pressing too hard on keys
Not holding your mouse too tightly or for too long
Avoiding moving the pointer with your thumb or wrist. Movement should originate at your shoulder and elbow.
Floating your arms above the keyboard and keep your wrist straight when keying.
2. Avoid Overreaching
Keep the mouse and keyboard within close reach.
Center the most frequently used section of the keyboard directly in front of you.
Center the monitor in front of you at arm's length distance and position the top of the monitor 2” to 3” above seated eye level. You should be able to view the screen without turning or tilting your head up or down.
Place source documents on a document folder positioned between your monitor and keyboard. If there is not enough space, place documents on an elevated surface close to your screen.
3. Maintain good posture:
Rest against the backrest of your chair (not slouching though)
Keep your knees at the same level or lower than your hips
Keep your feet supported
Keep your elbows in a slightly open angle (100° to 110°) with your wrists in a straight position.
4. Take breaks:
Take 1 or 2 minute breaks every 20-30 minutes, and 5 minute breaks every hour. (I may for example wash and dry a small load of clothes or fold clothes while doing an assignment at home.)
Take eye breaks and intermittently refocus on distant objects. Try palming your eyes in your hands to reduce eye fatigue. (I may recite a few bible verses or mentally review my to do list).
Billy Graham once noted that "God has given us two hands, one to receive with and the other to give with." In the same vein, Audrey Hepburn said "As you grow older, you will discover that you have two hands, one for helping yourself, the other for helping others."
It is in our hands, that is, our responsibility to ensure that we look after our hands and treat them well so that we can help ourselves and others.
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