Hand pain
The hand is the busiest part of the body: twenty-seven bones, some thirty joints and around fifty tendons, almost all of them working without a break.
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Medicines commonly prescribed for Hand pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: GEL, 23.2 mg/gActive substance: diclofenacManufacturer: Sandoz Farmaceutica S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: DRESSING, 140 MGActive substance: diclofenacManufacturer: Teva Pharma S.L.U.Prescription not required
The hand is the busiest part of the body: twenty-seven bones, some thirty joints and around fifty tendons, almost all of them working without a break. So it hurts often, and nearly always for one of a small number of recognisable reasons that differ from each other not in how much they hurt but in exactly where the pain sits and what brings it on. Sorting that out is worth the effort, because it decides whether a night splint will help, whether the way you use the hand needs changing, or whether it is time to see a doctor — some of these are not things a cream will fix.
First: the hand or the whole arm
This page is about the hand itself: the wrist, the palm, the back of the hand, the fingers and the thumb. The distinction matters, because the causes in the hand and in the rest of the arm are different ones.
If what hurts is not the hand but the elbow, the forearm or the whole arm from the shoulder down, that is a neighbouring subject with a page of its own: "Elbow and arm pain". Look there if you recognise yourself in any of this:
- the bony point on the outer side of the elbow hurts, and it is worse when you turn a key or wring out a cloth;
- a soft lump has swollen up on the tip of the elbow;
- the little finger and half the ring finger go numb, with a strip of numbness along the inner edge of the forearm, and it all gets worse when the elbow stays bent;
- the pain runs down as a band from the neck, across the shoulder blade and shoulder and into the arm, and worsens when you turn your head or cough;
- it is hard to lift the arm out sideways, to sleep on that side, or to reach behind your back.
And the most important thing of all. Heaviness, a dull ache or tightness in the arm that does not depend on hand movement, that comes with pressure behind the breastbone, breathlessness or a cold sweat, or that spreads to the jaw and back, may be a heart attack. Call an ambulance on the single European emergency number 112 and do not try to make your own way there. That pain has nothing to do with the hand and is not a matter for this page.
When you cannot wait
Immediately, on 112 or at the nearest emergency department:
- the hand or a finger is bent out of shape after an injury, pointing at an unnatural angle, or the finger will not straighten or bend at all, or there was a crack or a snap at the moment of injury;
- the hand is cold, pale or bluish, feeling has gone, and the pulse at the wrist is weaker than on the other side. That is a problem with the blood supply, and it is counted in hours;
- pain after an injury or a tight dressing is building and will not settle with painkillers, the hand feels bursting, and straightening the fingers hurts. Swelling in a closed space can squeeze the vessels from within;
- the wound is deep or gaping, a tendon is visible, or something is still embedded in the hand.
The same day, not tomorrow:
- redness with heat and fever: the joint or the whole hand is hot and swollen, any movement causes sharp pain, and there are shivers. That is how an infected joint presents, and it destroys the joint within days;
- redness spreading across the hand and up the forearm, particularly after a jab, a splinter, a cut or a bite, whether human or animal. Bite wounds on the hand become infected especially readily, and an antibiotic is given straight away rather than "if it gets worse";
- a finger swollen evenly like a sausage, held slightly bent, agonising to straighten, and tender all the way along the palm side. That is infection in the tendon sheath, and the tendon can be lost within a day;
- any hand wound in someone with diabetes, with a weakened immune system, or having chemotherapy.
Numb at night, and you shake the hand
This is the most recognisable picture in the whole subject. Someone wakes in the small hours because the hand is numb and aching, hangs it out of the bed, shakes it or rubs it, and within a few minutes it eases. By day the same thing happens at the wheel, holding a book, or with a phone against the ear. The thumb, index and middle fingers and half the ring finger go numb; the little finger stays out of it, and that detail matters, because a numb little finger points to a different nerve and to the elbow. The ache often travels up the forearm, which sends people looking for the cause higher up for no reason.
This is carpal tunnel syndrome: the median nerve squeezed in a narrow tunnel at the level of the wrist. It is commoner in women, in pregnancy, with an underactive thyroid, with diabetes and in people who work with vibrating tools.
What helps: a firm splint holding the wrist straight during sleep, the most effective of the home measures; and rethinking whatever is being done with the wrist bent or twisted. In pregnancy it usually clears on its own after the birth. What must not be missed: if weakness sets in and stays, if things start dropping out of the hand, and if the muscle pad at the base of the thumb has flattened compared with the other side, the nerve is already suffering, and from then on delay is expensive. Those changes do not always recover, and not always fully.
Pain at the base of the thumb
Two different conditions live side by side here, and they are treated differently.
Arthritis at the base of the thumb. The pain sits deep and low down, in the hollow beside the wrist. Pinching is the worst of it: opening a jar, turning a key, wringing out washing, doing up a button, fishing keys out of a pocket. Over time the joint broadens and becomes visible, the thumb loses its range, and a grating appears at the base. It is commoner from the forties and fifties onwards, and commoner in women. A splint, thicker grips, adapted kitchen tools and taking load off the pinch movement all help.
De Quervain's tenosynovitis. This one hurts not at the base itself but on the side of the wrist on the thumb side, where the bone juts out. The pain is sharp, travels up the forearm and into the thumb, and appears when you move the thumb away from the hand or tilt the hand towards the little finger — lifting a baby under the arms, for instance, or pouring from a heavy teapot. Sometimes there is a faint creaking. It is classic in the parents of small babies and after work the wrist is not used to. A splint that holds both the wrist and the thumb, resting that particular movement, and, if it does not settle, an injection given by a doctor.
The easiest way to tell them apart is by site: the arthritis hurts in the hollow at the very base of the thumb, De Quervain's two or three centimetres higher, right on the edge of the wrist.
The finger clicks and jams
In the morning the finger is bent and will not straighten smoothly: it resists and then springs out with a click, as though a trigger had been released. Sometimes it has to be straightened with the other hand, and in advanced cases it stays bent for good. A tender nodule can be felt at the base of the finger, in the palm.
This is trigger finger: a thickened tendon no longer running freely through its pulley. The thumb, middle and ring fingers are affected most often, and it is commoner in people with diabetes and with thyroid disease. It is not dangerous in itself, but nor will rubbing it away work. A night splint holding the finger straight helps, as does avoiding hard gripping; if the clicking persists, an injection around the pulley or a small operation is the answer, and both are decided at a consultation.
A cord in the palm and a finger that will not straighten
It begins quietly: a firm nodule appears in the palm, most often below the ring or little finger, with the skin above it slightly puckered. Over time a taut cord runs from the nodule to the finger, the finger gradually curls towards the palm, and one day the person notices they can no longer lay the hand flat on a table.
This is Dupuytren's contracture, an overgrowth of connective tissue in the sheet of the palm. It is not an inflammation and usually barely hurts, which is why it goes unshown for so long. It is commoner in men, increases with age, and runs with family history, diabetes, smoking and heavy drinking. Neither massage nor creams nor pulling on the finger will undo it. The time to show the hand is when the finger starts getting in the way of everyday tasks, or when the palm no longer sits flat on a table: that simple test is how the question of surgery is decided, and done in good time it gives the better result.
When it is inflammation rather than wear
Everything above is a local, mechanical story. But there is one picture in which home measures are pointless and dangerous for the time they waste.
- Morning stiffness lasting more than half an hour, sometimes half the morning: the hand has to be worked loose before it does anything.
- Symmetry: the same joints hurt and swell on both hands at once.
- Small joints: the knuckles and the middle joints of the fingers are puffy, warm and soft to the touch, and rings no longer go on. The joints closest to the nails are usually spared.
- Alongside this come general tiredness, a slight temperature, pain in the feet and weight loss.
This is how rheumatoid arthritis starts. It is a whole-body disease rather than a worn joint, and the key point is a single one: most of the joint damage happens in the first year or two, and treatment started early prevents it. So this picture is a reason to book an appointment and have blood tests, not to buy another tube of cream. Separately, sudden ferocious pain with redness and heat in a single joint, commoner in men, too tender to touch, is how gout behaves; that is also for a doctor, and testing distinguishes it from infection.
What you can do yourself
While the cause is being worked out, some harmless measures apply to almost all of the above.
- Take away not all activity but exactly the movement that reproduces the pain. Complete rest does the hand harm: joints stiffen quickly.
- Take rings off at the first sign of swelling; later they have to be cut off.
- Cold helps in the first days after an injury and in a fresh flare; warmth helps with old, stiff pain and morning stiffness. Always apply either through a cloth.
- A night splint is the most underrated measure in carpal tunnel syndrome and trigger finger. It should hold the wrist straight, not merely squeeze it.
- Change your tools: thick handles instead of thin, a jar opener instead of your fingers, a forearm support when typing, a bag strap over the shoulder rather than in the hand.
- For pain relief, paracetamol or anti-inflammatories, including gels applied to the spot. Check the choice and the dose with a doctor or pharmacist, particularly with stomach or kidney problems and in older people.
- Keep the hand raised if it swells, and move the fingers gently every day.
What not to do: massage a painful spot through severe pain, work off a fresh injury, put a finger back into place yourself, or spend months covering with painkillers a hand in which numbness or weakness is increasing.
Online consultation
The hand is a subject where good questioning does half the work. Remotely, a doctor can pin down exactly where the pain sits and which movement brings it on, separate carpal tunnel syndrome from thumb-base arthritis and from pain arriving from the neck or elbow, explain what morning stiffness and symmetry mean and which blood tests are worth doing, advise which splint you need and how to wear it, go through the loads on your hands at work and at home, and read any images and reports you already have. Some conditions — trigger finger, De Quervain's, an early Dupuytren's — are recognised almost unfailingly from the account and a short video of the hand moving.
The limits of the format are worth stating plainly: a screen cannot feel a joint, test strength against resistance or assess a fresh injury. And for a deformity after a fall, a cold pale hand, spreading redness with a fever, or a suspected heart attack, what is needed is an ambulance rather than a message.
This material is for information only and does not replace medical advice.
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