General information
There are numerous causes for pain in the back of the hand. Among the most common are tendosynovitis, carpal tunnel syndrome and the so-called RSI syndrome. But also joint or tendon injuries as well as arthrosis or gout can cause pain in the back of the hand. The cause can usually be found by suitable imaging. The therapy of pain in the back of the hand ultimately depends on the underlying disease.
Causes for pain in the back of the hand
The causes for pain in the back of the hand are very diverse and often they are not even in the back of the hand itself. Possible causes are generally injuries in the back of the hand, the wrist, but also other parts of the hand, degenerative changes or inflammation. The following is an overview of possible causes for pain in the back of the hand.
Carpal tunnel syndrome is a so-called compression syndrome, in which the median nerve is compressed in the carpal canal. The carpal canal is a bony canal in the area of the wrist, which is additionally limited by ligaments. If there is an increase in pressure in the canal, for example due to tissue swelling, inflammation or a predetermined anatomical narrowing, the median nerve can become trapped.
This typically leads to paresthesia in the area supplied by the nerve, including the thumb, but also to motor disorders and pain. The pain may radiate diffusely from the carpus into the arm and the rest of the hand, so that the back of the hand may also hurt with advanced compression. Initially, the symptoms occur more frequently after exertion, such as gripping or lifting heavy loads.
Later, however, the pain also occurs at rest. The diagnosis is made by physical examination and measurement of the nerve conduction velocity of the median nerve, which is reduced in carpal tunnel syndrome. Both conservative and surgical measures are used for therapy.
In conservative therapy, splints, anti-inflammatory and analgesic drugs are used. Corticoids are also used in therapy because of their anti-inflammatory effect. In surgical therapy, there are various surgical techniques in which the median nerve is relieved.
Tendovaginitis, also known as tendovaginitis, is a quite common disease. In principle, tendovaginitis is possible wherever there are tendon sheaths or tendon fans. The wrist and the tendon fans of the extensor tendons on the back of the hand are particularly frequently affected.
There are six tendon fans on the back of the hand, through which nine muscle tendons run. When these tendon fans become inflamed, the back of the hand hurts, but the pain can also spread to other parts of the hand. There are both infectious and non-infectious causes for tendon sheath inflammation in the back of the hand.
Infectious tendosynovitis usually occurs after stab wounds or other injuries to the hand that allow pathogens to enter the tendon sheaths. Non-infectious causes are mainly permanent strain on the tendon sheaths (e.g. through sports). The hand is strained in particular by poor posture and non-ergonomic computer work, so that office workers, for example, are more likely to have tendinitis of the tendon sheath.
In acute inflammation, the affected tendon compartment is painful under pressure and can be swollen, reddened and overheated. The pain in the back of the hand can also occur at rest and shows little improvement through immobilization. Chronic inflammation can also cause a nodular thickening of the tendon, which can also be felt under the skin.
In addition, there may be a crunching and frictional noise during movements. In the clinical examination, the doctor palpates the painful back of the hand and can determine which tendons are affected based on the location of the pressure pain. If anything is unclear, the MRI and ultrasound diagnostics can also be used to map the focus of the inflammation.
If the physician suspects that the inflammation is due to a rheumatic disease, he or she will also determine the relevant blood parameters using blood samples. The therapy of a tendosynovitis is usually conservative. It is important to spare and immobilize the affected tendon.
The latter can be achieved, for example, with splints and stabilizing bandages. In addition, affected persons can apply anti-inflammatory creams and take pain-relieving and anti-inflammatory medication. These include NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin or ibuprofen.In addition, occupational therapy and physiotherapy can provide relief.
For very severe and chronic complaints, local anaesthetics (local anaesthetics) and cortisone preparations are also used to reduce the inflammation and pain. In rare cases a surgical intervention is performed. The RSI syndrome is a medical term for painful complaints such as arm, neck and hand complaints after repetitive activities.
Colloquially this is also called secretary’s disease or mouse arm. It must be distinguished from specific clinical pictures such as carpal tunnel syndrome or tendosynovitis. Especially for office workers and other employees, who often perform such activities (e.g. computer work), back pain in the back of the hand is due to overstraining the hand.
This can be prevented by adequate rest breaks, a good sitting position and an ergonomic workplace. The therapy is similar to that of tendosynovitis. The affected hand should be spared.
If the pain is severe, painkilling and anti-inflammatory drugs can help. Carpal osteoarthritis is a degenerative disease (caused by wear and tear), which usually develops in the joint between the forearm bones and the carpal bones. Injuries to the wrist, for example, can lead to a small malposition of the carpal bones and thus cause arthrosis after a long time.
Chronic strain on the wrists and carpal bones can also cause such arthrosis. Not infrequently, carpal arthrosis occurs in connection with inflammatory diseases. Due to the wear and tear of the articular cartilage, the carpal bones are subject to greater friction, which can lead to (load-dependent) pain in the wrist and back of the hand.
A fracture of the wrist or metacarpus often leads to pain in the back of the hand. Typically, such fractures occur as a result of a fall that is caught with the hands. They cause pain especially when the hand is moved.
Other accident mechanisms such as getting your hand caught in a door can also cause a fracture. The therapy often consists of immobilizing the affected hand in a cast. If the carpal bones are more severely affected or the fracture is particularly complicated, surgery may also be necessary.
This is to prevent long-term consequential damage such as wrist arthrosis. Pain in the back of the hand can occur as part of many other diseases. However, these do not only cause pain in the back of the hand, but also other complaints. Some common causes of pain are listed below:
- Injuries to joints, ligaments and tendons
- Rheumatic diseases: Group of very different diseases with the common feature that they lead to pain and functional disorders in the musculoskeletal system
- Arthrosis: Degenerative disease that causes wear and tear of the joints
- Arthritis: inflammation of the joints with different causes
- Muscle injuries: Torn muscle fibers, pulled muscles, sports injuries
- Gout and attacks of gout: metabolic disease in which uric acid crystals are deposited in joints
- Osteoporosis: a disease of the skeletal system in which bone density decreases, leading to an increased tendency to fracture and pain
- Circulatory disorders and thrombi
- Ganglion: benign tumor that can form in the area of joint capsules and superficial tendon sheaths and can sometimes be painful
