Arthritis and Diseases That Affect the Hand and Wrist
From joint inflammation to compressed nerves, problems that may be to blame for painful hands and wrists.
Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the wrist and fingers. Other conditions can cause additional problems, such as numbness and tingling, pitted nails, painful ulcers or thickened skin that makes bending the fingers difficult. Here are some possible disease-related problems that affect the hands and wrists.
- Osteoarthritis (OA). The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. In the hand, the joints most commonly affected by osteoarthritis are the wrist, the joint at the base of the thumb (the basal joint), the joint in the middle of the finger (proximal interphalangeal joint or PIP) and the joint closest to the nail (distal interphalangeal joint or DIP). In the finger joints, OA can lead to the formation of bony knots. In the PIP joint these are call Bouchard's nodes. In the DIP joint they are called Heberden's nodes.
- Rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. Rheumatoid arthritis commonly affects the wrist and finger joints and can cause deformities that make it difficult to use the hands.
- Juvenile arthritis (JA). Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis that can cause pain and swelling in the wrist and joints of the hands.
- Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the wrist and joints of the fingers. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin of the hands.
- Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. A small percentage of people with the disease develop a rash or hard nodules on the soles of their feet or palms of their hands.
- Lupus. Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints. The wrist and small joints of the hands are among those most commonly affected by lupus. Lupus can also cause inflammation in many organs, including the skin, heart, lungs and kidneys.
- Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. The joint involvement of psoriatic arthritis often causes inflammation of the entire finger, giving it a sausage-like appearance. Approximately 80 percent of people with psoriatic arthritis experience changes to the nails including pitting, thickening and/or separation from the nail bed. The skin rash of psoriatic arthritis can also affect the hands.
- Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi and can affect the joints of the hands.
- Raynaud's phenomenon. Raynaud’s phenomenon is a condition characterized by a narrowing of the blood vessels to the extremities, usually the hands, in response to cold temperatures or stress. When blood vessels close down, fingers become cold and white, then blue, and numb or painful. When the vessels open up again, the hands become red or purple. Raynaud’s is often associated with connective tissue diseases, notably scleroderma.
- Osteoporosis. Osteoporosis is a condition in which the bones lose enough mass that they become brittle and prone to breaking with slight trauma. The bones of the wrist are among those most commonly fractured in people with osteoporosis. The condition can occur with aging, inflammatory disease (such as rheumatoid arthritis) inactivity, a low-calcium diet or use of corticosteroid medications.
- Carpal tunnel syndrome. This condition occurs when the median nerve, a nerve that runs from the forearm into the hand and supplies sensation to the palm and thumb side of the hand, becomes compressed within the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by bones and a ligament, through which the median nerve and several tendons run. If there is swelling within the tunnel, the nerve can become compressed, resulting in pain, weakness, and/or numbness in the hand and wrist, radiating up the arm.
- Scleroderma. Literally translated "hard skin," scleroderma is an umbrella term for disorders that involve the abnormal growth of the connective tissue supporting the skin and internal organs. Although there are several different forms of scleroderma, all can cause thickening and tightening of the skin on the fingers called sclerodactyly. This can make it harder to bend or straighten the fingers.
- Dermatomyositis. Dermatomyositis is an inflammatory muscle disease that often has a severe onset. Symptoms can include muscle pain and weakness, joint pain, skin rash, changes around the beds of the fingernails and roughening and cracking of the skin on the palms and fingertips, often referred to as Mechanic's hands.
- Dupuytren’s contracture. Dupuytren's contracture, sometimes called Dupuytren's disease, is an abnormal thickening of the fascia, a flat band of tissue beneath the skin, in the palm of the hand. This can lead to the development of firm cords and lumps that cause the fingers to bend toward the palm. The ring and little finger are most commonly affected. The disease, which occurs primarily in men older than age 40 of European descent, less commonly affects the fascia on the soles of the feet.
- Ganglion cysts. Ganglion cysts are lumps that form next to the joints or tendons in the hand and wrist. The most common locations are the joints at the base of the fingers (metacarpophalangeal joint or MCP), joints closest to the nail (distal phalangeal joint or DP), the top of the wrist and the palm side of the wrist. These cysts can occur in people of any age, they may come and go for no apparent reason, and they may or may not be painful.
- Stenosing tenosynovitis (trigger finger). This condition, also known as trigger finger, occurs when the pulley (one of the rings connective tissue that hold tendons of the fingers close to the bone) at the base of a finger or thumb thickens, constricting the tendon that enables the finger to move. This can cause popping, pain or a catching feeling in the finger or thumb. In some cases, repeated use can worsen inflammation and make it difficult to straighten or bend the finger.