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Chapter 13: Wrist and Hand Pain

Robin I. Burks; Stephen Schnall

Description of the Symptom

Wrist and hand pain, as discussed in this chapter, includes diffuse/general wrist and hand pain, central wrist pain, radial wrist pain, ulnar wrist pain, dorsal hand pain, palmar hand pain, and digit pain. Local causes of wrist and hand pain are defined as pathology that occurs within the distal one-quarter of the radius and ulna, carpals, metacarpals, and phalanges; component articulations of the wrist and hand; and associated soft tissue structures. Remote causes are defined as those occurring outside this region.

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Special Concerns

  • Decreased pulses

  • Fracture with suspected skin break

  • Pain in bilateral hands provoked with cervical movements

  • Pain out of proportion to the injury

  • Severe edema following trauma in areas with fascial muscle compartments

  • Skin break and fever

  • Sudden or progressive paresthesia or loss of sensation associated with trauma

  • Warmth and swelling associated with a fever or purulent drainage

CHAPTER PREVIEW: Conditions That May Lead to Wrist and Hand Pain
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CHAPTER PREVIEW: Conditions That May Lead to Wrist and Hand Pain
T Trauma
REMOTE LOCAL DIFFUSE/GENERAL WRIST AND HAND LOCAL CENTRAL WRIST LOCAL RADIAL WRIST LOCAL ULNAR WRIST LOCAL DORSAL HAND LOCAL PALMAR HAND LOCAL DIGITS
COMMON

Radiculopathies:

  • C6 radiculopathy 214

    Ulnar nerve compression at the elbow (cubital tunnel syndrome) 218

 Not applicable

Fractures:

  • Capitate and lunate fractures 221

  • Distal radioulnar joint fracture/dislocation 221

    Lunate dislocation 225

Nerve injuries:

  • Median nerve compression at the wrist (carpal tunnel syndrome) 226

Scapholunate ligament sprain 231

Fractures:

  • Distal radius fracture 222

  • Scaphoid fracture 223

  • Thumb metacarpal base fracture (Bennett's or Rolando's fracture) 224

Nerve injuries:

  • Radial sensory nerve injury (without entrapment) 227

Fractures:

  • Distal radioulnar joint fracture/dislocation 221

  • Distal radius fracture 222

  • Distal ulna fracture 222

  • Hamate fracture (non-hook) 222

  • Pisiform fracture 223

  • Triquetrum fracture 224

Lunotriquetral ligament tear (and lunotriquetral dissociation) 226

Fractures:

  • Metacarpal fractures (including Boxer's fracture) 223

Nerve injuries:

  • Radial sensory nerve entrapment (Wartenberg's syndrome) 226

  • Radial sensory nerve injury (without entrapment) 227

Fractures:

  • Hamate fracture (hook) 222

Nerve injuries:

  • Median nerve compression at the wrist (carpal tunnel syndrome) 226

Acute central slip rupture (Boutonnière deformity) 218

Flexor digitorum profundus avulsion/rupture (jersey finger) 221

Fractures:

  • Phalangeal fracture 223

  • Thumb metacarpal base fracture (Bennett's or Rolando's fracture) 224

Interphalangeal joint dislocation 225

Nerve injuries:

  • Median nerve compression at the wrist (carpal tunnel syndrome) 226

  • Radial sensory nerve injury (without entrapment) 227

Terminal extensor tendon rupture (Mallet finger) 234

Ulnar collateral ligament tear (Gamekeeper's or Skier's thumb) 237
UNCOMMON

Pronator syndrome 214

Radiculopathies:

  • C7 radiculopathy 214

  • C8 radiculopathy 215

Thoracic outlet syndrome 216

 Not applicable Not applicable

Nerve injuries:

  • Radial sensory nerve entrapment (Wartenberg's syndrome) 226

Nerve injuries:

  • Ulnar nerve compression at the wrist (Guyon's canal) 227

Triangular fibrocartilage complex tear 234

 Not applicable Not applicable

Nerve injuries:

  • Ulnar digital nerve compression (Bowler's thumb) 227

Subungual hematoma 232
RARE...

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