The hands are intricate structures composed of 27 bones, numerous joints, tendons, nerves, and specialized skin, enabling fine motor skills and powerful grip. Their complexity and constant use make them susceptible to a wide variety of diseases and physical afflictions. Understanding these conditions is key to managing the pain, stiffness, and loss of function that can severely impact daily living.
Joint and Bone Conditions
The most common conditions affecting the hand’s skeletal structure are various forms of arthritis, which cause inflammation and structural degradation within the joints. Osteoarthritis (OA), often called “wear and tear” arthritis, involves the gradual breakdown of the cartilage that cushions the ends of bones. This deterioration leads to bones rubbing against each other, causing pain, stiffness, and a grinding sensation, particularly with movement.
In the hands, osteoarthritis frequently targets the joints closest to the fingertips, known as the distal interphalangeal (DIP) joints, as well as the middle joints (PIP) and the base of the thumb joint. As the condition progresses, hard, bony lumps can form around these affected joints, which are a characteristic sign of the disease. Stiffness is typically worse after periods of rest but often improves throughout the day with movement.
Rheumatoid Arthritis (RA) is an autoimmune disorder where the immune system mistakenly attacks the joint lining, called the synovium. This inflammatory process results in joint swelling, tenderness, and warmth, often affecting the same joints on both hands symmetrically, such as the knuckles and wrists. Morning stiffness lasting longer than 30 minutes is a distinguishing feature, and RA can cause systemic symptoms like fatigue.
Gout is another inflammatory type of arthritis caused by an excessive buildup of uric acid in the bloodstream, which forms needle-like crystals within the joints. Although gout most famously affects the big toe, it can also cause acute, severe episodes of redness, swelling, and intense pain in the wrist and finger joints. Untreated gout can lead to the formation of visible, painless chalky lumps called tophi under the skin around the joints.
Nerve and Tendon Disorders
The hands rely on nerves for sensation and tendons for movement, both of which can be compromised by compression or inflammation. Carpal Tunnel Syndrome (CTS) is a frequent nerve disorder resulting from pressure on the median nerve as it passes through the carpal tunnel in the wrist. This compression causes numbness, tingling, and a sensation similar to an electric shock, typically in the thumb, index, middle, and half of the ring finger, sparing the little finger.
Symptoms often worsen at night or while performing activities that involve holding the wrist in a flexed or extended position, such as driving or holding a phone. Chronic pressure on the nerve can eventually lead to hand weakness, making it difficult to grip objects or perform fine motor tasks. The underlying cause is often multifactorial, including repetitive wrist motions and swelling of the surrounding tendon sheaths.
Conditions affecting the tendons, often called tenosynovitis, include Trigger Finger (stenosing tenosynovitis). This occurs when the flexor tendon or its sheath becomes inflamed or thickens, leading to a small nodule that struggles to glide smoothly through the pulley system at the base of the finger. The result is a catching, popping, or locking sensation when the finger is bent or straightened, most commonly affecting the ring finger and the thumb.
De Quervain’s Tenosynovitis involves inflammation and swelling of the sheaths surrounding two specific tendons on the thumb side of the wrist. This condition causes pain and tenderness at the base of the thumb, often radiating up the forearm, particularly when grasping, pinching, or twisting the wrist. It is frequently associated with repetitive hand movements, such as those performed by new parents lifting an infant.
Dupuytren’s Contracture involves the thickening and shortening of the fascia, a layer of tissue beneath the skin of the palm. This process begins with the formation of painless nodules that develop into tough cords running along the palm and into the fingers. As the cords contract, they pull the fingers inward toward the palm, resulting in a progressive flexion contracture, most often seen in the ring and little fingers.
Skin and Vascular Afflictions
The hands are prone to various dermatologic issues and problems related to blood circulation due to constant interaction with the external environment. Hand eczema, or hand dermatitis, is a common inflammatory skin response characterized by the following symptoms:
- Redness
- Intense itching
- Peeling
- Painful cracking
This condition is often triggered by irritant contact dermatitis from frequent hand washing, exposure to harsh chemicals, or solvents, which strip away the skin’s natural protective barrier.
Paronychia is an infection of the skin fold around the nail, known as the perionychium. Acute paronychia is caused by bacteria entering through a break in the skin from trauma, such as nail-biting or aggressive manicuring, leading to rapid onset of redness, swelling, and pus formation. Chronic paronychia often involves fungal organisms and is more common in individuals whose hands are frequently wet, like bartenders or dishwashers, due to the constant disruption of the nail fold seal.
Raynaud’s Phenomenon is a vascular issue characterized by episodic, excessive constriction of the small arteries in the fingers. This vasospasm is triggered by exposure to cold temperatures or emotional stress, causing a distinctive sequence of color changes in the digits. The fingers first turn white (pallor) due to lack of blood flow, then blue (cyanosis) from oxygen deprivation, and finally red (erythema) as blood flow returns, often accompanied by numbness or burning pain.
Raynaud’s can occur as a primary condition, with no known underlying cause, or as a secondary phenomenon linked to other autoimmune or connective tissue diseases, such as lupus or scleroderma. The thumb is often spared in primary Raynaud’s, and while the episodes are reversible, the secondary form carries a higher risk of complications due to underlying structural abnormalities in the blood vessels.