History and examination of the adult with hand pain
- Philip E Blazar, MD
Philip E Blazar, MD
- Assistant Professor of Orthopedic Surgery
- Harvard Medical School
The multiple functions of the hand are extremely important for daily life, and any deviation from normal function can lead to disability. It is important for the clinician to recognize the various traumatic and nontraumatic disorders that can lead to hand pain and dysfunction.
The history and evaluation of the adult with hand pain will be reviewed here. The differential diagnosis is lengthy, and this review will focus on some of the more common diagnoses. Thumb and wrist pain, as well as fractures and infections of the hand, are discussed in detail separately. (See "Evaluation of the patient with thumb pain" and "Evaluation of the adult with acute wrist pain" and "Overview of finger, hand, and wrist fractures" and "Overview of hand infections".)
Understanding the anatomy of the hand is necessary to identify the source of pain and limit the differential diagnosis. The bones of the hand include five metacarpals, two phalanges in the thumb, and three phalanges in each of the other fingers (figure 1). The joints of each finger include the metacarpophalangeal (MCP), the proximal interphalangeal (PIP), and the distal interphalangeal (DIP); the thumb has only one interphalangeal (IP) joint.
Extrinsic muscles of the hand originate in the forearm and elbow area. The extrinsic flexor tendons for each digit travel in a fibro-osseous tunnel between the distal metacarpal and the DIP joint. The superficialis tendon attaches to the middle phalanges, and the profundus tendon attaches to the base of the distal phalanges. The extrinsic extensor tendons pass over the dorsum of the wrist in six separate tunnels that are labeled as compartments.
Intrinsic muscles of the hand include the thenar, hypothenar, interosseous, and lumbricals. The thenar muscles control abduction and opposition of the thumb; other thumb movements are controlled by forearm muscles. The interosseous and lumbrical muscles collectively flex the MCP joints while extending the IP joints, and the interosseous muscles also abduct and adduct the fingers.
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- COMMON CAUSES OF HAND PAIN
- Inflammatory arthritis
- Trigger finger (stenosing flexor tenosynovitis)
- Ganglion cyst
- Dupuytren's contracture
- Carpal tunnel syndrome
- Mallet finger
- Physical examination
- - Inspection
- - Palpation
- - Range of motion
- - Strength testing
- - Special tests
- ADDITIONAL STUDIES
- Injections and aspirations
- Laboratory testing
- Electrodiagnostic testing
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS