Why is there a pain in hand ?

Dr KK Pandey *

Now-a-days you will find people frequently complaining of pain in hand. Either their wives or parents do suffer from pain in hand quite often. Sometimes people complain of both pain and swelling in hand simultaneously. Sometimes the pain in hand is so severe in intensity that it causes disturbance in sleep during night time. Have you ever thought why do pain and swelling occur in your hand ?

If only pain in hand but no swelling

These days, majority of the people especially working class follow a daily routine where in, there is no place for daily morning walk and exercise. Heavy workload in offices and strenuous travelling day in and day out are increasing physical and mental stress. This causes weakness of shoulder muscles responsible for maintaining stability of your shoulder to keep it in proper place.

This results into drooping of shoulder that exerts undue pressure upon nerves emerging from your brain and travelling to hand via your neck. This pressure on nerves finally leads to pain and tingling sensation in hand. This condition is called in medical language as Thoracic Outlet Syndrome (TOS). This in a simple language means undue and excessive constricting pressure on a tunnel that opens from neck into an arm.

This pressure on this connecting tunnel may be possibly due to other reasons also. For example, an unnatural existence of an abnormal rib (cervical rib) emerging from spine of the neck or abnormal bony protuberance of spine on both sides of neck (Transverse process) exert excessive pressure on nerves passing through the tunnel and thus leading to pain in hand.

Sometimes, muscles of neck constrict abnormally and this puts nerves under pressure and a patient feels pain in hand whenever he shakes his neck. In other cases, an old chest injury sustained during previous road traffic accident becomes the main reason of pain and tingling sensation in hand.

If hand has pain and swelling both

Quite often ladies who are overweight and neither they walk regularly nor do exercise and keep sitting for hours together, suffer from the problem of pain in hand. The main reason is undue pressure on blood pipes carrying impure blood (veins) near shoulder. This causes insufficient return of impure blood upwards from hand to heart leading to abnormal accumulation of impure blood in hand and forearm.

This results simultaneously into pain and swelling in hand. Sometimes if blood clots clog the blood pipe carrying impure blood and completely blocks the upward flow of impure blood leading to rapid rise in pain and swelling in hand. This condition can get worse, if prompt treatment is not undertaken.

If hand has pain with discoloration of fingers too

This condition is prevalent in those people who are addicted to tobacco use or who have been smoking for many years. Tobacco has an element called Nicotine in it, that causes constriction of blood pipes which carry oxygen rich pure blood to hand.

This narrowing of blood pipe will lead to decrease in supply of pure blood to hand. This results into pain in hand as well as discoloration of finger tips. If no proper measures are taken promptly, there will remain no other option except amputation of fingers.

One more reason of discoloration of fingers is the disease of vasculitis. In this disease, inflammation and swelling in the wall of blood pipes occur. This inflammation of wall narrows down lumen of blood pipe and thus flow of pure blood to hand is hampered, with the result, pain and tingling sensation start in hand and fingers and gradually fingers start turning black. This inflammatory condition of vasculitis is generally caused by autoimmune disease and disorders.

If hand has pain as well as ulcer

This problem occurs in those women who are very much emotional by nature and remain mentally distressed most of the time. This problem happens mostly in winters. What exactly happens is, due to excessive sensitivity to cold, supply of pure blood to fingers gets suddenly disturbed and finally almost stopped, that results into blue discoloration of fingers first, then colour changes into pale and then becomes red finally due to restoration of pure blood supply again.

If this incidence of colour changing of fingers due to cold happens repeatedly, small ulcers in finger tips near nails start appearing. This disease is called Raynaud’s phenomenon. The symptoms of this disease mostly appear in winter season. Therefore, patients suffering from this disease should avoid exposure to cold.

If hand has pain and tingling sensation both

If your hand has pain and tingling sensation in some of the fingers, it could be due to a condition called cervical spondylitis. Sometimes along with this pain in hand, there is complaint of giddiness or vomiting also and generally people mistake these problem for either abdominal disease or brain disease. In cervical spondylitis, the enlarged spine bone in neck exerts pressure on nerves emerging from spine.

This results into mild pain and tingling sensation in hand that generally persist during the day time. In the beginning, one can control this problem by doing specific neck exercises and reducing weight. If carelessness persists, this problem becomes permanent and always worrying the sufferers.

If pain and tingling sensation confined to fingers only

The most important cause of this problem is the medical condition called “Carpel Tunnel Syndrome”. In this condition unnecessary and excessive pressure on a nerve (Median Nerve) is exerted inside the wrist that leads to pain and tingling in the fingers. If the wrist is bent forward, pain in fingers increases in intensity.

Sufferers of this often have disturbed problem disturbs the sleep in the night time. If timely treatment of carpel tunnel syndrome is not undertaken, beside pain and tingling sensation, muscles of hand too slowly getting weakened progressively.

Some important investigations required

If you are suffering from pain in hand, some important investigations are required, like Chest X-ray, CT of neck and special test like NCV of hand. At the same time, special investigations of blood pipes of neck, arm and hand like arterial and venous Doppler study are also essentially desirable. Sometimes, CT angiography is also required.

Besides these investigations, some specialized blood investigations, like RA factor, ANA, and Anti dsDNA are required. Above all some important special blood investigations to rule outany defect by birth in clotting mechanism of blood are also needed.

Where to go for this problem in hand

Always go to a centre where department of Vascular Surgery as well as Thoracic Surgery exist. Also ensure there is an availability of a full time Vascular surgeon in the hospital. At the same time there should be availability of modern investigations like angiography, CT, NCV and Doppler investigations. Besides these facilities of investigations, an ultramodern ICU facility must be there in the hospital.

Various modes of treatment

In majority of the cases, with pain and tingling sensation in hand, immediate surgery is not generally required. Daily morning walk for 5 kilometers and some special exercises are required. Body weight has to be controlled. It is very essential to get exposure to sunlight for 2 to 3 hours.

During summers, one should expose oneself to sunlight between 6 am and 9 am. During winters, one can enjoy sunlight at anytime of the day. At the same time, some special medications are to be taken. One must follow all these advices for at least 6 months.

Various modes of surgery

One must understand, there is no guarantee of hundred percent relief from pain in hand even after surgery. The outcome of surgery depends upon the patient’s weight and daily routine. If there is pressure on the nerve in the neck, surgical removal of the first rib gives a considerable relief in pain in hand. Sometimes surgical removal of culprit extra cervical rib gives some relief in pain.

Sometimes surgical removal of extra protuberance of transverse process is done to reduce pressure on nerve. If there is deposition of clot in blood pipe, cleaning of blood pipe is done by surgical removal of blood clots to restore blood supply. If there is a pressure on nerve in hand, surgery is required to remove that pressure.