An Approach to Progressive Hand Pain
A common question was raised on social media about someone dealing with progressive hand pain for years, despite normal inflammatory lab results. What should be the next step?
Assessing the Type of Pain
The first step is to determine whether the pain is due to inflammatory arthritis, degenerative arthritis, tendonitis, or neuropathic pain. Different hand issues require different approaches, and identifying objective evidence is key.
- Pain Symptoms: Are the pains accompanied by joint swelling, numbness, tingling, or are they worse in the morning with stiffness, or after physical activity?
- Physical Examination: Are there signs of inflammation, wear and tear arthritis, or could it be a pinched nerve issue?
Diagnostic Tools
Diagnostic imaging is important. Musculoskeletal ultrasound is excellent for evaluating soft tissues like tendons, ligaments, inflammation, and subtle nerve impingements. X-rays help detect joint damage or wear and tear arthritis.
Lab Tests and Inflammatory Parameters
Even with normal inflammatory parameters, it’s important to check the correct antibodies. Some inflammatory conditions, such as early-stage rheumatoid arthritis, may not show up in blood tests, with up to 50% of early cases being antibody-negative.
Treatment Options
Treatment depends on the diagnosis:
- Inflammation: Typically treated with medication.
- Instability: Exercises, bracing, and regenerative medicine.
- Neuropathic Pain: Physical therapy, splinting, and possibly regenerative treatments.
If multiple conditions are present, conservative treatment is recommended. Occupational therapy, over-the-counter supplements, and reassessing progress are key steps.
Conclusion
Start with low-risk options, reassess, and adjust treatments based on response. The goal is to provide relief and prevent hand pain from worsening over time.
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