Upper Extremity Pain
Pain in the upper extremities, like, fingers, hands, wrists, and elbows, is a very common complaint patients often present with, in primary healthcare settings. There are multiple origins and causes of such pain.
Each of these disorders presents with a specific type and character of pain, in a specific part of your upper limb and is associated with specific aggravating and relieving factors. Therefore, it is possible to identify the underlying cause of pain based on mere history and clinical presentation.
This article will help you understand what the possible causes of upper extremity pain are, how to identify them, and what treatment options are available to cure such conditions.
What are the Potential Causes of Upper Extremity Pain?
Different causes of upper extremity pain along with their pain character, associated symptoms, risk factors, etc, are described below.
One of the leading causes of pain in the hand, wrist, and elbow is the inflammation of joints, known as arthritis. In this condition, a dull and burning pain is felt in the joints, which increases with gripping or repetitive movements. Besides, the joints appear warm, swollen, and may also show stiffness which is typically observed in the morning when you wake up.
There are more than 100 different types of arthritis but the most common types which affect the joints of the upper extremity are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is usually prevalent among old people. It results from deterioration of joint cartilage caused by age-related wear and tear. On the other hand, rheumatoid arthritis is an autoimmune disease that affects different parts of the body, and joints are one of its initial targets. Both hands get affected in the same manner at the same time.
Carpal Tunnel Syndrome
If you are feeling pain, numbness, or tingling in your thumb, index, middle and radial half (thumb side) of the ring finger, it is an indication that you are suffering from carpal tunnel syndrome. The pain may aggravate at night, and relieves with ice, rest, or flicking/shaking of hand and wrist (flick sign).
Carpal tunnel syndrome is the most common nerve entrapment disorder which arises due to compression of the median nerve during its course through the small passageway, known as carpal tunnel, in the wrist.
It is usually seen in women, obese individuals, or people, such as computer users, construction workers, etc, who do repetitive movements of the wrist like typing, using vibrating equipment, etc. Other risk factors may include pregnancy, menopause, hypothyroidism, and rheumatoid arthritis.
Cubital Tunnel Syndrome
It is the second most common nerve compression syndrome of the upper limb following carpal tunnel syndrome. It occurs when the ulnar nerve gets compressed at the elbow where it passes through a narrow space (cubital tunnel) having very little soft tissue to protect it.
Cubital tunnel syndrome is characterized by pain, numbness, and tingling on the inside of the forearm and hand extending into the little finger and inner half of the ring finger. The pain feels like “pins and needles” and is aggravated by bending the elbow.
In more severe cases, there may be decreased sensations in the respected area, weakening of grip, difficulty in finger coordination, and muscle wasting in hand.
De Quervain’s Tenosynovitis
If the pain is localized to the base of your thumb and outer (thumb) side of your wrist and gets elevated when you rotate your wrist, make a fist, or try to grasp or pinch something, it might be the pain of De Quervain’s tenosynovitis.
De Quervain’s tenosynovitis is a painful disorder in which the two tendons present at the base of the thumb, along with their tendon sheath, get inflamed and thickened and restrict the thumb movements.
The exact cause is still unclear; however, it has been associated with repetitive wrist motions, rheumatoid arthritis, pregnancy, etc. It is also seen in baby-caring mothers who frequently lift their children by using their thumbs as leverage.
It is a muscle strain injury caused by repetitive contractions and overuse of forearm muscles involved in gripping and wrist extension. The pain of the tennis elbow develops slowly and is typically present on the outer part of the elbow where forearm muscles attach to the bony bump. It may also radiate into your forearm and wrist. Pain worsens with activity and is relieved with rest.
Tennis elbow is a very common complaint in individuals who play racquet sports like tennis, badminton, and squash. Plumbers, carpenters, butchers, and painters also develop this condition as their jobs feature such types of wrist movements.
It is similar to the tennis elbow; however, its pain occurs at the inner aspect of the bony bump of the elbow. The pain increases with gripping, throwing, or moving forearm, and decreases with cessation of activity. You may also observe elbow stiffness, swelling, numbness, or tingling on the inside of the elbow and forearm.
Golfer’s elbow develops when there is overuse of forearm muscles controlling the clenching of fingers and rotation and flexion (bending) of the wrist. People who play racquet sports, throwing sports (American football, archery, javelin throwing, etc), do weightlifting or are plumbers, construction workers, carpenters, etc, often present with golfer’s elbow pain.
Dupuytren’s contracture is a condition that affects a layer of tissue (palmar fascia) lying under the skin of the palm. Initially, small nodules are formed beneath the skin which joined together to form a thick cord that pulls one or more fingers towards the palm. Usually, the middle, ring, and/or little finger are most commonly affected. The finger/s remains in a bent position and cannot be straightened.
Dupuytren’s disease is generally painless; however, it is sometimes associated with pain. The pain has been attributed to the nerve compression caused by the fibrous tissue formation or the disease itself.
Sprain and Strain
Sprain and strain of the wrist joint are very common and usually occur due to a fall onto an outstretched hand, or due to an impact on the wrist during sports, for example with a ball, etc.
A sprain occurs when the ligaments of the wrist joint are overstretched or torn, while if such injury happens to tendons, it is regarded as wrist strain. Pain is present in the wrist and is associated with swelling, bruising, weakening, and restricted movements.
The pain of the trigger finger presents as discomfort on the palmar aspect of the base of one or more fingers. Pain is experienced during the bending (flexion) of the affected digit/s. The finger or thumb becomes stiff and moves with a painful click. It may also get locked in its position when you try to extend it from a fixed flexed position.
The condition develops when there is irritation or inflammation of the tendon sheath (protective cover around muscle tendon) of a finger’s tendon. As a result, nodules or thickening occurs in the tendon which interferes with the normal bending and extension of the finger.
Another condition that may cause upper extremity pain is cervical radiculopathy which is caused by compression of nerve roots at the level of the cervical (neck) spine due to degenerative changes or herniation of the intervertebral disc.
A severe pain radiates in the arm, forearm and may reach up to the hand in a dermatome or myotome pattern. It increases with neck extension and is relieved by placing the hand over your head. There may also be numbness or tingling sensations.
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