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Wrist & Hand Pain/Swelling

Contents
  1. Read book excerpt
  2. Pain Disorder: Introduction
  3. Pain Disorder Misdiagnosis
  4. News
  5. Pain Disorder Overview
  6. More book excerpts for Pain Disorder

Wrist & Hand Pain/Swelling: Excerpt from In a Page: Signs and Symptoms

The wrist is composed of eight carpal bones that are held in alignment by a series of ligaments and cartilaginous connective tissue. Wrist pain is fairly common in primary care. Although carpal tunnel syndrome is one of the most common etiologies of wrist pain, pain and numbness in the hand is a more common presentation.

Differential Diagnosis

  • Carpal tunnel syndrome
    –Most common cause of significant wrist discomfort and morbidity
    –Associated with repetitive use activities (e.g., typing)
    –Pain and numbness symptoms result from entrapment of the median nerve under the transverse ligament
  • Overuse injury
  • Osteoarthritis
  • Tenosynovitis (DeQuervain's) of the radial wrist
    –Results from inflammation of the tendon sheaths of the extensor pollicis brevis and abductor pollis longus
    • Ganglion cysts
      –Common growths of tendons and ligaments in the wrist area occurring on both the dorsal and ventral surface
      –They are compressible, round, often tender, and mobile
    • Trauma
      –The most common mechanism of injury is a fall on the outstretched hand
      –The most commonly fractured carpal bone is the scaphoid
      –Other mechanisms include direct blows, crush injuries, fall on an angulated wrist, and severe twisting motions
    • Fibromyalgia
    • Compartment syndrome
    • Chest or shoulder masses, resulting in compression of lymphatic or venous systems
    • Venous thrombosis of the subclavian or distal veins
    • Flaccid paralysis following a CVA
    • Angioedema secondary to hymenoptera sting
    • Rheumatologic disease
    • Peripheral neuropathy
    • Insect or animal bite/sting
    • Infection (e.g., staphylococcus aureus, streptococci)

    Workup and Diagnosis

    • History and physical examination of the hand, wrist, elbow, and shoulder
      –Tinel's sign is positive if pain is elicited by tapping the anterior wrist
      –Phalen's sign is positive if wrist flexion for >30 seconds elicits pain or numbness
    • Lab investigation is usually unnecessary, but may include rheumatoid factor, ANA, ESR, CBC, uric acid, TSH, β-hCG (pregnancy test)
  • Standard X-rays include PA, lateral, and oblique views
  • EMG and nerve conduction studies are indicated if carpal tunnel syndrome or other neuropathy is suspected
  • Arthrocentesis with crystal analysis may be indicated if warmth and redness are noted in the wrist and MCP joints
  • Bone scan may be necessary to evaluate for avascular necrosis, occult fracture, or bone infection
  • Rarely, CT or MRI is indicated
  • Shoulder/chest CT may be indicated to evaluate for masses resulting in nerve entrapment or vascular compromise

Treatment

  • Corticosteroid injection for carpal tunnel improves symptoms in more than half of patients; surgical intervention to release the transverse ligament and decompress the nerve entrapment may be indicated
  • NSAIDs reduce inflammation and use of cock-up splints applied during activities and while sleeping reduces strain from repetitive use and reduces symptoms
  • Corticosteroid injection along tendon sheaths and wearing a thumb spica splint treat tenosynovitis
  • Ganglion cysts are treated by draining the thick fluid and injecting with steroid; surgical removal is occasionally necessary
  • Casting of suspected fractures and repeat X-ray in 7–9 days prevents complications of occult fracture
  • Antihistamines and steroids treat swelling from stings
  • Treat rheumatologic and medical causes
  • Biofeedback and relaxation may be beneficial in selected cases

Book Source Details

  • Book Title: In a Page: Signs and Symptoms
  • Author(s): Scott Kahan, Ellen G. Smith
  • Year of Publication: 2004
  • Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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  • Back pain
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  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Leg Pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Neck pain
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  • Rectal pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Throat pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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  • Chest Pain, Atypical
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  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
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  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
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  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Leg pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Throat pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
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  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Leg pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X

 » Next page: Ankle Pain/Swelling (In a Page: Signs and Symptoms)

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