“If this blog helped you out, don’t keep it to yourself—share the link on your socials!” 👍 “Like what you read? Spread the love and share this blog on your social media.” 👍 “Found this useful? Hit share and let your friends know too!” 👍 “If you enjoyed this post, please share the URL with your friends online.” 👍 “Sharing is caring—drop this link on your social media if it helped you.”

Monday, August 18, 2025

Pain in the palm of the hand


Introduction

The palm of the hand contains a dense concentration of bones, tendons, ligaments, nerves, and blood vessels that enable fine motor skills, grip, and sensation. Pain in this region can be caused by mechanical stress, trauma, repetitive use, nerve compression, systemic disease, or infection.

Because the hand is essential for daily activities, even mild pain can significantly impair function and quality of life. The underlying causes range from benign overuse syndromes to serious systemic or neurological conditions.

Anatomy of the Palm

  • Bones: carpals, metacarpals, phalanges.

  • Joints: carpometacarpal (CMC), metacarpophalangeal (MCP), interphalangeal (IP).

  • Muscles and Tendons: flexor digitorum superficialis/profundus, lumbricals, thenar/hypothenar muscles.

  • Nerves: median nerve (supplies most palmar sensation), ulnar nerve (supplies hypothenar and medial palm), radial nerve (small palmar contribution).

  • Vessels: superficial and deep palmar arches.

Disorders affecting any of these structures can produce palm pain.

Causes of Palmar Hand Pain

1. Musculoskeletal / Mechanical

  • Overuse syndromes: repetitive gripping, typing, tool use.

  • Trigger finger (stenosing tenosynovitis): thickening of flexor tendon sheath → painful locking of fingers.

  • Dupuytren’s contracture: palmar fascia thickening → nodules, cords, contractures.

  • Palmar ganglion cysts: soft lumps causing pressure discomfort.

  • Arthritis: osteoarthritis (base of thumb, MCP), rheumatoid arthritis.

  • Tendonitis / flexor tendon injury.

2. Neurological

  • Carpal tunnel syndrome (CTS): compression of median nerve → palm pain, numbness, tingling (especially thumb, index, middle fingers).

  • Ulnar nerve entrapment (Guyon’s canal syndrome): palm and little finger pain/numbness.

  • Peripheral neuropathy: diabetic neuropathy, alcohol, chemotherapy-induced.

3. Traumatic

  • Fractures (metacarpals, phalanges).

  • Dislocations/sprains.

  • Contusions from blunt trauma.

4. Vascular

  • Ischemia / Raynaud’s phenomenon.

  • Thrombosis or embolism of palmar arch vessels.

5. Infectious / Inflammatory

  • Palmar abscesses or cellulitis.

  • Herpetic whitlow (HSV infection).

  • Septic arthritis / flexor tenosynovitis – a surgical emergency.

6. Systemic Causes

  • Diabetes mellitus: predisposes to neuropathy, infection, Dupuytren’s.

  • Autoimmune diseases: rheumatoid arthritis, lupus.

  • Gout / pseudogout: crystal deposition in MCP joints.

Clinical Presentation

  • Pain characteristics: sharp, aching, burning, throbbing.

  • Location: localized to base of fingers, central palm, or diffuse.

  • Associated features:

    • Swelling, nodules, lumps (ganglion, Dupuytren’s).

    • Clicking/locking (trigger finger).

    • Numbness, tingling (carpal tunnel, ulnar neuropathy).

    • Stiffness (arthritis).

    • Redness, warmth (infection, gout).

    • Loss of grip strength.

Red flags: severe pain with swelling, fever, spreading redness (possible infection); sudden pain with deformity (fracture); vascular compromise (cold, pale hand).

Diagnostic Evaluation

1. History

  • Onset: acute (trauma, infection) vs chronic (arthritis, neuropathy).

  • Occupation / repetitive use.

  • Nighttime symptoms (carpal tunnel).

  • Past medical history: diabetes, autoimmune disease, gout.

2. Examination

  • Inspection: swelling, deformity, nodules.

  • Palpation: tenderness, ganglion cysts, cords in Dupuytren’s.

  • Range of motion: restricted in arthritis, trigger finger.

  • Neurovascular exam:

    • Tinel’s sign, Phalen’s test (carpal tunnel).

    • Froment’s sign (ulnar nerve weakness).

  • Vascular pulses, capillary refill.

3. Investigations

  • X-ray: fractures, arthritis, gouty erosions.

  • Ultrasound: tendonitis, ganglion cysts.

  • MRI: soft tissue lesions, nerve entrapment.

  • Nerve conduction studies / EMG: confirm carpal tunnel or ulnar neuropathy.

  • Blood tests: uric acid, ESR/CRP, rheumatoid factor, ANA (if systemic disease suspected).

  • Culture: abscess aspirates.

Management

Treatment depends on underlying cause, but general goals are pain relief, preservation of function, and treatment of the underlying condition.

1. General and Supportive Measures

  • Rest and activity modification.

  • Splinting: wrist splints for carpal tunnel, finger splints for trigger finger.

  • Physiotherapy: stretching, strengthening, ergonomic training.

  • Heat or cold packs depending on condition.

2. Pharmacological Treatment

a) Analgesics and Anti-inflammatory Drugs

  • Paracetamol (acetaminophen): 500–1000 mg orally every 6 hours (max 4 g/day).

  • NSAIDs:

    • Ibuprofen: 400 mg orally every 6–8 hours with food.

    • Naproxen: 250–500 mg orally twice daily.

    • Diclofenac sodium: 50 mg orally three times daily or topical gel applied 3–4 times daily.

b) Neuropathic Pain (CTS, ulnar neuropathy, diabetic neuropathy)

  • Gabapentin: start 300 mg orally daily, titrate to 900–1800 mg/day.

  • Pregabalin: 75 mg orally twice daily (max 600 mg/day).

  • Amitriptyline: 10–25 mg orally at night.

c) Corticosteroid Injections

  • For trigger finger, carpal tunnel, arthritis.

  • Triamcinolone acetonide 10–40 mg injected into tendon sheath or carpal tunnel by specialist.

d) Gout Management

  • Colchicine: 500 mcg orally 2–3 times/day until resolution (max 6 mg per attack).

  • Indomethacin: 50 mg orally three times/day.

  • Long-term: Allopurinol 100–300 mg orally daily (urate-lowering).

e) Infections

  • Flucloxacillin: 500 mg orally four times daily × 7 days (cellulitis/abscess).

  • Clindamycin: 300 mg orally four times daily (if penicillin-allergic).

  • Severe cases: IV antibiotics and surgical drainage.

3. Specific Treatments

  • Carpal Tunnel Syndrome: splints, NSAIDs, corticosteroid injection, surgical release if severe.

  • Trigger Finger: splinting, steroid injection, surgical release if refractory.

  • Dupuytren’s Contracture: collagenase injection (clostridial collagenase) or surgical fasciectomy.

  • Ganglion Cyst: aspiration, surgical excision if persistent.

  • Arthritis: NSAIDs, disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (e.g., Methotrexate 7.5–25 mg orally once weekly).

  • Palmar Abscess / Tenosynovitis: urgent surgical drainage, IV antibiotics.

  • Fractures: immobilization or surgical fixation.

Complications

  • Loss of hand function (grip, dexterity).

  • Chronic pain syndromes.

  • Nerve damage (carpal tunnel, untreated entrapment).

  • Permanent contractures (Dupuytren’s).

  • Sepsis (untreated infections).

  • Disability affecting work and daily life.

Prognosis

  • Overuse injuries and mild tendonitis: excellent with rest, splints, and therapy.

  • Carpal tunnel: good with conservative or surgical management.

  • Trigger finger: usually resolves with injections or minor surgery.

  • Dupuytren’s: chronic, progressive, recurrence common even after surgery.

  • Rheumatoid arthritis: variable; early DMARDs improve outcomes.

  • Infections: good prognosis with prompt drainage and antibiotics.

  • Fractures: recovery depends on severity and timely treatment.

Preventive Measures

  • Ergonomic hand use (computer, tools).

  • Regular breaks from repetitive tasks.

  • Stretching and strengthening exercises.

  • Protective gloves for manual labor.

  • Good control of systemic conditions (diabetes, gout, RA).

  • Early treatment of minor injuries or infections.

Pharmacological Quick Reference

  • Pain relief:

    • Paracetamol 500–1000 mg q6h (max 4 g/day).

    • Ibuprofen 400 mg q6–8h.

    • Naproxen 250–500 mg BD.

    • Diclofenac 50 mg TDS.

  • Neuropathic pain:

    • Gabapentin 300–900 mg/day (up to 1800 mg).

    • Pregabalin 75 mg BD (max 600 mg).

    • Amitriptyline 10–25 mg nocte.

  • Steroid injections:

    • Triamcinolone 10–40 mg intra-sheath/intra-carpal tunnel.

  • Gout:

    • Colchicine 500 mcg TDS.

    • Indomethacin 50 mg TDS.

    • Allopurinol 100–300 mg OD.

  • Infections:

    • Flucloxacillin 500 mg QDS.

    • Clindamycin 300 mg QDS (if penicillin allergy).

  • RA (specialist initiation):

    • Methotrexate 7.5–25 mg once weekly.



on

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)