The hand is the most complex area of the upper limb in its structure. It consists of many bones, closely grouped together. Bones are connected through 30 different joints - mesophalangeal, metacarpophalangeal, carpometacarpal and radiocarpal.
According to statistics, hands are injured much more often than any other part of the body. According to various sources, various injuries account for 30 to 50% of the total number of musculoskeletal injuries and do not tend to decrease.
Therefore, of all the causes of pain in the fingers, the main one is trauma. In second place in terms of prevalence are connective tissue diseases - rheumatoid arthritis, systemic scleroderma and lupus erythematosus, psoriasis. Much less often, pain in the joints of the fingers is due to a violation of metabolic processes in gout, osteoarthritis.
Symptoms
The signs of non-traumatic injuries that may indicate the presence of joint pathology are the following:
- pain syndrome, which is permanent or wavy.
- pain when pressing and bending the fingers.
- swelling and redness of the skin over the joints.
- stiffness, stiffness during movements.
- deterioration of fine motor skills.
- squeaking, stinging and squeaking when fingering.
- the formation of subcutaneous nodules, painless to the touch.
- thickening of the skin in the folds.
- change in the configuration of the joints.
- increase in body temperature.
Rheumatoid arthritis
Rheumatoid arthritis most often affects the fingers and the right and left hand at the same time. This systemic disease is characterized by a malfunction of the immune system, in which T-lymphocytes begin to attack their own cells. The cells of the synovial membrane that line the capsule of the joint from the inside produce active rheumatic factors: pathological antibodies are protective protein molecules.
Rheumatic agents then enter the bloodstream and bind to normal antibodies. As a result, immune complexes are formed that settle in blood vessels and tissues. They are absorbed by cells of the immune system - neutrophils and phagocytes, releasing substances that damage the surrounding structures.
It is known that this is how inflammation develops in rheumatoid arthritis. However, scientists have not been able to determine the cause of this process. According to the latest research in this field, the culprits of connective tissue damage are the cytokines - cells of the immune system that signal. Japanese experts have concluded that studying this type of cell will help find an effective method of treatment.
With rheumatoid arthritis, any finger can hurt - index, middle, ring or little finger, but the lesion will always be bilateral. If one or more fingers on the left hand get sick, then the same fingers on the right hand start to hurt almost immediately.
The phalanges in the area of the joints swell and redden, due to the accumulation of fluid, they do not bend well, especially in the morning. Morning stiffness can last up to 1 hour. Over time, the progression of arthritis leads to the replacement of smooth cartilage tissue with a fibrous structure, which disrupts the free movement of bone in the joint.
Gradually, the joints become deformed, due to a change in the position of the joint elements, the pain intensifies. With a long course of the disease, small painless formations appear near the joints in the back of the hand - rheumatic nodules.
Psoriatic ARTHRITIS
The symptoms of this disease can look like rheumatoid arthritis and appear against the background of a dermatological pathology - psoriasis. In the vast majority of cases, first skin rashes appear and after a while the finger joints ache.
It is also possible for skin and joint damage to occur at the same time; in 20 percent of patients, the joints begin to ache earlier. Why psoriasis occurs is unknown. It can possibly be caused by a genetic predisposition, immune system dysfunction and infections. The average age of patients is 40 years.
Psoriatic arthritis can start, like rheumatoid arthritis, with general weakness and malaise or it can manifest with unexpected feelings of sharp pain. Not only the toes but also the small joints of the legs, knees and shoulders can be affected. Participation in the pathological process can be both unilateral and symmetrical.
The pain syndrome is more intense at night and at rest. In the morning there is stiffness, during the day and with movements the pain subsides. Most often, there is a lesion on one side - on the left or right, and, as a rule, it hurts not one, but 2-4 joints (oligo-arthritis).
After many hours of rest, the fingers become very swollen and become like sausages, the tendons of the flexor muscles become inflamed, the skin above the joints acquires a purple-bluish tinge. The following symptoms indicate the presence of psoriasis and psoriatic arthritis:
- red or pink scaly spots on the head, elbows, knees and thighs - may be solitary or cover a large area of skin.
- characteristic cavities on the skin of the hands, similar to smallpox, pigmentation on the fingers or toes.
- Psoriasis plaques are hyperemic, edematous and may cause itching.
- Joint pain is permanent and does not subside during the day.
- the mobility and functionality of the hand is significantly reduced.
The arthropathic form of psoriasis is one of the most serious. Deformity of the joints is usually not observed, but if this happens, then fusion of the articular surfaces of the bones (ankylosis) is not ruled out.
The risk of this disease is that the large joints and the spine are gradually involved in the pathological process. Osteoporosis develops, the joints are destroyed, so psoriatic arthritis often leads to disability.
Osteoarthritis
With arthropathy, the process of cartilage tissue that covers the articular surfaces of the bones is disrupted. This is facilitated by both external and internal factors - injuries, high physical activity, hereditary predisposition and metabolic disorders.
Depending on the cause, arthropathy can be primary or secondary, developing in the background of an endocrine or metabolic disease. Most often, arthritis affects the large joints of the lower limbs - knee, hip and ankle - because they carry the main load when walking and standing. The upper extremities are affected much less often.
When the fingers ache due to prolonged physical exercise and after rest the pain disappears, the development of arthritis is not ruled out.
Over time, other symptoms appear:
- increased pain when clenching a fist or stretching the fingers.
- increase in the size of the affected joint.
- stiffness in the morning, which requires the "growth" of the fingers for 10-15 minutes or more.
- characteristic squeaking when you bend your fingers.
Osteoarthritis develops slowly and may not be a major concern for several years or even decades. However, in some cases, there is a rapid increase in symptoms and a sharp deterioration of the condition. If at first the pain appears only during the effort, then later it does not subside even after rest.
Due to the marginal increases in the bones that form the joints, characteristic epiphyseal formations occur. Bouchard nodules form closer to the palm, in the proximal phalangeal joints. Next to the distal interphalangeal joints, near the nails, are the Heberden nodules.
Stenotic ligament
Stenotic ligamentitis affects the ligament-tendon apparatus of the hand and is manifested by obstruction of one of the fingers at the flexion or extension position. The pathological process is caused by overload or excessive pressure in the area of the joints, so the disease occurs in people engaged in manual labor - builders, welders, seamstresses and kitchen workers. In children, stenotic ligamentitis is extremely rare and only affects the thumb.
The main symptom of the disease is the "jump" of the finger to the extent, accompanied by a click. In the future, the "snap" disappears and the finger remains motionless, turning it into a tensile flexion or contraction.
In the early stages, there is pain when pressing the palm at the base of the finger and difficulty in bending / stretching, especially intense in the morning. With a long course of ligamentitis, you can move your finger only with the help of the other hand and after the "crunch" there is pain that spreads not only to the palm, but also to the forearm.
Which doctor should I go to?
For pain in the fingers, you can first contact a therapist who, if necessary, will refer you to a specialist - a traumatologist, rheumatologist, hematologist, neurologist or surgeon. Clinical, radiological and laboratory research methods are used for diagnosis.
To determine the cause of the pain, a delivery (taking a history) and a physical examination are performed, after which an x-ray or tomography, blood and urine tests are prescribed.
Treatment
How you will be treated and what you will do next will depend on the test results. Number 1 is the relief from pain and inflammation: for this, drugs from the NSAID group are prescribed - non-steroidal anti-inflammatory drugs. New generation, selective action NSAIDs are now increasingly used.
Selective NSAIDs act selectively and have less toxic effects on the body, they can be taken for a long time. If the pain syndrome is moderate or mild, topical agents are used - anti-inflammatory ointments and gels.
The treatment of rheumatoid arthritis includes basic and biological products, steroid hormones. These drugs suppress the immune system, thus reducing the intensity of the inflammatory process.
The same immunosuppressive drugs are prescribed if the joints ache in the background of psoriatic arthritis. Methods such as plasmapheresis, hemorrhage, and photochemotherapy are used to reduce disease activity, prolong remission, and shorten the duration of drug treatment.
The treatment of joint pain depends on the stage of the disease. In stages 1-2, it is possible to significantly slow down the cartilage destruction by taking chondroprotectants. Physiotherapy is effective, which enhances the effect of drugs and stimulates recovery processes.
For the treatment of arthritis can be prescribed:
- magnetotherapy?
- electrophoresis?
- laser;
- ultrasound;
- Cryotherapy - exposure to joints with liquid nitrogen.
- Spa therapy - baths with mineral water.
- irudotherapy - during treatment with leeches, substances that promote cartilage regeneration (hirudin, vitamins and hormones) enter the joint.
The treatment regimen for stenotic ligamentitis is determined taking into account the stage, the presence of provocative factors and the age of the patient. If the damage to the joints is minimal, it is recommended to reduce the load on the hand, if necessary, the hand is fixed with a rectum or splint. For pain, anti-inflammatory drugs and hyaluronidase electrophoresis are prescribed.
The treatment of the second stage begins with conservative methods. Lack of action for several months is an indication for surgery to cut the damaged ligament. In patients with the third stage, conservative treatment is performed extremely rarely, in most cases the surgery is performed as scheduled.
Note: Due to the high risk of recurrence, it is very important to change profession if this involves a load on the hands.
Folk remedies
Folk remedies can not be the main method of treatment, as they are not effective enough. However, as an adjunct therapy, such drugs will help relieve pain and enhance the effect of the drugs.
Mix a few bay leaves with juniper needles, add a little butter and massage your hands with the resulting ointment.
In the evening, you can make a compress of crushed chalk, kefir, fermented baked milk or boiled oatmeal.
Green potatoes are used for compresses, which must be sliced directly on the skin in a meat grinder or grater. Then dip the potato porridge in hot water and heat to 39-40 °. After that, place it in a linen bag and apply on sore joints for half an hour. The procedure can be done several times a day.
Paraffin applications relieve pain well if you put your hands in melted paraffin for 10 minutes and then hold them in any herbal decoction for 15-20 minutes. You can not be afraid of burns, as paraffin melts at a temperature no higher than 65 °. To achieve the result, 2-3 applications per week are enough.
Bischofite compresses help accelerate tissue healing. Due to its composition, this natural mineral relieves pain and inflammation, restores joint mobility. Regular use of Bishofit maintains muscle and connective tissue tone.
A Bischofite compress is recommended as follows: warm the joints with a heating pad or hold them in a warm bath and then rub Bischofite, previously diluted 1: 1 with water, on the skin of the hands. The rubbing should be continued for several minutes, after which a cloth or gauze soaked in the solution is applied to the sore spot. From above, the compress is covered with polyethylene and insulated. Bischofite compresses are made in the evening, in the morning hands are washed well with warm water. The procedure is performed every other day for three weeks.
Note: a Bischofite compress can be applied to no more than three joints at a time.
The most important
To prevent or reduce the intensity of the pain that has already occurred, you must keep the brushes warm and do not expose them to hypothermia. Work that requires the same type of movement is best done at intervals and when using vibrating tools, use gloves and support the work brush with the other hand. When lifting and transporting heavy loads, the weight of the load must be evenly distributed at both ends. You can also maintain healthy joints with the help of proper nutrition, which should include foods that contain calcium and omega-3 fatty acids.