Articolar painsfingers are an indispensable sign of any joint pathology in which the structural components of these joints are damaged. First of all, pain in the area of these joints can be associated with various autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, etc.), in which immune factors cause damage to one's joint tissues.
The next main reason that can startachein the area of the joints of the fingers, there may be injuries (bruises, dislocations, bone fractures, ligament damage). Pain in these joints can also be triggered by degenerative changes in their joint tissues. This can often be seen in osteoarthritis.
Anatomy of the joints of the hand
All joints of the hand are generally divided into the following groups:
- wrist joint;
- wrist joints;
- carpometacarpal joints;
- intercarpal joints;
- metacarpophalangeal joints;
- interphalangeal joints.
The wrist joint is formed by the connection of the bones of the proximal (higher) wrist row (trihedral, lunate, scaphoid bones) and distal portions of the radius and ulna. The ulna is not directly connected to the wrist bones, but via the distal (bottom) articular disc. This structure separates the cavity of the wrist joint from the cavity of the distal (bottom) of the radioulnar joint.
Wrist joints are represented by three types of joints. The first type includes those joints that are located between the bones of the upper (navicular, lunate, triangular, pea-shaped) or bottom row (hook-shaped, capitate, trapezoidal, osseo-trapezoidal). These joints are called intercarpal joints. The second type is the so-called mid-carpal joint. This joint is S-shaped and is formed by connecting the bones of the upper and lower rows of the wrist. The third type is the pisiform bone joint. Through this joint, the triangular bone is connected to the pisiform bone.
The carpometacarpal joints connect the wrist and metacarpal bones. These joints are formed by the contact of the proximal extremities (reasons) of the metacarpal bones and distal sections of the carpal bones belonging to the second row. The carpometacarpal joints comprise two major joints. The first is the carpometacarpal joint of the thumb. It is formed by the junction of the first metacarpal bone with the trapezius bone.
The second joint is the common carpometacarpal joint for the rest of the carpometacarpal joints between the second, third, fourth, fifth metacarpal bone and the trapezius bones, capitate, hook-shaped and, in part, the seat of the trapezius bone. The carpometacarpal joint of the thumb is separated from the common carpometacarpal joint. Due to this, more active movements are possible in it, compared to the rest of the carpometacarpal joints (which are part of the common carpometacarpal joint), which are considered inactive. The carpometacarpal joints are reinforced with strong joint capsules and ligaments (dorsal and palmar carpometacarpal ligaments).
The lateral surfaces of the second, third, fourth and fifth metacarpal bones, when in contact with each other, form intercarpal joints. These joints have separate joint capsules that approach and join the carpometacarpal joint capsules. In addition to the capsule, these joints have a ligamentous apparatus, represented by the interosseous metacarpal ligaments, as well as the dorsal and palmar metacarpal ligaments. The intercarpal joints are classified as sedentary joints of the hand, since the joint surfaces of the bones that form these joints are flat.
The metacarpophalangeal joints are the joints between the distal (inferior) ends of the metacarpal and proximal bones (higher) areas of the first phalanges of the fingers. Each finger of the upper limb has its own metacarpophalangeal joint. Therefore, there are five metacarpophalangeal joints on each of the arms.
The interphalangeal joints are formed by joining adjacent phalanges of each of the fingers. Great (first) the finger has only one interphalangeal joint, since this finger has only two phalanges (proximal and distal). The rest of the fingers of each hand have two interphalangeal joints.
The former is located between the former (proximal) and the second (average) phalanges of the fingers and is called proximal (higher) interphalangeal joint. The second forms a connection between the medium (second) and the last (distal) phalanges of the fingers. The second interphalangeal joints are called distal interphalangeal joints. The interphalangeal joints are reinforced by collateral and palmar ligaments. These joints belong to the block joints, in which movements are possible only around the frontal plane (extension and flexion).
What structures can become inflamed in the joints of the hands?
Inflammation is a typical pathological process characteristic of those tissues and organs that have been damaged for any reason. It is worth remembering that, in most cases, any disease (for example, gout, rheumatoid arthritis, etc.) or an injury that damages the joints of the hands in one way or another, affects not only the joint, but also the periarticular one (nerves, muscles, tendons, subcutaneous fat, skin) structure.
The following joint structures can become inflamed in the joints of the hands:
- articular cartilage;
- subchondral bone tissue;
- Joint capsule;
- joint ligaments.
Causes of pain in the joints of the hand and fingers
The main part of the causes of pain in the joints of the hand and fingers is mechanical injury (fractures, dislocations, bruises, etc.) and systemic autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, psoriasis, etc.). In addition to these reasons, pain in the joint area of the hands can cause diseases associated with metabolic disorders (eg gout, osteoarthritis).
There are the following main causes of pain in the joints of the hand and fingers:
- bruised hand and fingers;
- fracture of the bones of the hand;
- dislocation of the hand;
- damage to the ligaments of the hand;
- rheumatoid arthritis;
- Kienbeck's disease;
- reactive arthritis;
- psoriatic arthritis;
- systemic lupus erythematosus.
Bruised hand and fingers
Bruising is one of the types of closed injuries, in which soft tissue damage occurs (muscles, tendons, nerves, skin) and there are no wounds in the place where the main action of the traumatic factor was directed. Soft tissue bruises of the hand and fingers are very rare in isolation (separately) from bruises of the joints of the hand and fingers. Thus, with this type of injury, mixed symptoms occur, indicating both damage to the joints of the hand and damage to the periarticular (periarticular) fabrics. Hand and finger bruises usually occur when the hand falls, is damaged by a blunt object, or when it is squeezed or pinched.
Quite often, bruises of the wrist area lead to damage to the main trunks of the median, radial, ulnar nerves (which innervate the area of the hand and fingers), which manifests itself immediately with the loss of skin sensitivity, and in some cases even the disappearance of the motor functions of the fingers.
Inflammatory edema of the joint and periarticular structures develops as a result of the expansion of the numerous vessels that supply them with blood. This edema is one of the inflammatory reactions that occur in response to tissue damage from injury.
Fracture of the bones of the hand
Quite often, the cause of pain in the joints of the hand can be various fractures of its bones, since these bones are directly involved in the formation of the joint surfaces. Depending on the anatomical location of the injured bone, all fractures are divided into three main groups. The first group includes fractures of the wrist bones. The second includes fractures of the tubular metacarpal bones. The third group includes fractures of the bones of the phalanges of the fingers.
The most common sites of injury in the wrist area of the hand are the lunate and scaphoid bones. A fracture of these bones occurs when it falls on the hand and is accompanied by pain in the wrist and mid-carpal joints. Pain syndrome can also be observed in the places of the anatomical localization of these bones.
The most common fracture of the ends of the metacarpal bones is a fracture of the base of the first metacarpal bone (that which is adjacent to the phalanges of the thumb bones). With this injury, swelling and pain appear in the area of the base of the first metatarsal bone, as well as in that part of the carpometacarpal joint, which is directly adjacent to it. With such a fracture, the thumb is shortened, bent and brought to the palm. His movements are limited.
Fractures of the phalanges of the hand are accompanied by deformation, decrease in the length of the fingers, loss of their function, acute pain and swelling of the interphalangeal joints and periarticular tissues. In case of fractures of the phalanges of the fingers with displacement of bone fragments, palpation (on palpation), it is possible to identify their bulge on the palmar surface of the hand, and on the back, on the contrary, a fossa or retraction. This debris is generally mobile; you can often find subcutaneous bleeding near them (hematomas).
Dislocations of the hand
Dislocation is a pathological condition in which the portions of the bones that form any joint go beyond its anatomical boundaries, which, therefore, manifests itself with the total or partial loss of the function of this joint. In addition to impaired joint function in dislocations, there are also severe pain in the affected joint area, swelling and a local rise in temperature. With dislocations of the hand, the appearance of swelling is explained not only by the presence of inflammation in the damaged periarticular tissues, as well as in the structures of the joint, but also with the protrusion of the bone that has emerged from this joint.
The most common types of hand dislocations
|Name of the location||Dislocation mechanism||Which joint is affected?|
|True dislocation of the hand|
|Dislocation of the scaphoid|
|Dislocation of the first metacarpal bone|
|Dislocations of the phalanges of the fingers|
Injury of the ligaments of the hand
Ligament defeat, along with hand bruises, is referred to as closed traumatic injuries. This pathology is mainly manifested by excessive extension of the hand and fingers in any direction. The main types of hand ligament injuries are strain and rupture. When stretched in the damaged area, there is a slight razvlecheniya and partial rupture of the connective tissue fibers. When the ligaments are torn, the entire ligament is split into two unconnected ends.
There are the following main types of hand ligament tears:
- rupture of the radial collateral ligament of the wrist;
- rupture of the ulnar collateral ligament of the wrist;
- rupture of the intercarpal ligaments;
- rupture of the lateral ligaments of the metacarpophalangeal joints;
- rupture of the lateral ligaments of the interphalangeal joints.
Rheumatoid arthritis is a disease in which a person's immune system damages the body's tissues. In other words, rheumatoid arthritis is an autoimmune disease. This disease is also systemic, as it affects many tissues (muscles, joints, blood vessels, etc.) and organs (heart, kidneys, lungs, etc.) in the body.
Despite the fact that rheumatoid arthritis is a systemic disease, it is the joints that suffer the most, while damage to other tissues and organs takes a back seat. Almost all types of hand joints can be affected with this disease (radiocarpal, carpometacarpal, metacarpophalangeal, interphalangeal joints). Defeat is usually symmetrical (those. the same joints are affected) on both hands, accompanied by swelling, pain in the damaged joints. In the morning, as you get out of bed, you feel some stiffness in the affected joints, which can last about 1 hour and then disappear without a trace.
Quite often, with rheumatoid arthritis near the affected hand joints (most often metacarpophalangeal, interphalangeal joints) rheumatoid nodules appear. They are rounded formations located under the skin. On the other hand, these formations most often occur on the back side. On palpation, they are dense, inactive, painless. Their number can vary.
Kienbeck's disease is a disease in which the lunate carpal bone of the hand is affected. The disease develops due to prolonged physical overload of the palms. It usually occurs among specialists in the construction professions: plasterers, bricklayers, carpenters, etc. Excessive physical exertion of the palms very often damages this particular bone, as it occupies a central position in the wrist joint. Most often in Kienbeck's disease, one hand is affected and, as a rule, the main (right-handers injure their right hand, left-handers - the left).
Reactive arthritis is a pathology of immunopathological genesis, in which the body's immune system attacks various joints of the body, which is why autoimmune inflammation develops in them. Unlike other autoimmune diseases (for example, rheumatoid arthritis, systemic lupus erythematosus, which are suspected of being infectious) in reactive arthritis, there is a clear relationship between the previous infection (and in particular intestinal or urogenital) and the development of joint injuries.
Also, with this pathology, the lymph nodes can increase and fever may appear. With the transition of reactive arthritis into a chronic form, over time, patients may show signs of kidney disease, heart disease, decreased body weight, muscle atrophy, bursitis (inflammation of the periarticular bags), tendovaginitis (inflammation of the tendon sheaths) and so on.
Gout is a disease that is based on the accumulation of uric acid in the body and its deposition in the form of salts in the joints. Uric acid is the end product of purine and pyrimidine base exchange. They serve as the basis for the construction of DNA and RNA molecules, some energy compounds (adenosine triphosphate, adenosine monophosphate, etc.) and vitamins.
The pain of gout occurs mainly in the small joints of the lower and upper limbs. Furthermore, in 50% of all clinical cases, the disease begins with the first metatarsal joint of the legs. On the hands, as a rule, the interphalangeal joints of the fingers are affected, less often the wrist joints. Gout usually affects one or more joints in one limb, and joints in other limbs are sometimes involved.
Psoriatic arthritis is a pathology in which various joints become inflamed against the background of psoriasis. The development of psoriasis is based on a violation of the interaction between immune cells and skin cells, as a result of which in the body (and especially in the skin) there are autoimmune reactions that cause inflammation.
Synovitis is inflammation of the synovial membrane of the joints, accompanied by damage to its tissues and the accumulation of abnormal fluid in the affected joints. Synovitis is not a separate disease, but rather a complication of other diseases. It can manifest itself in endocrine, allergic, infectious, autoimmune pathologies, hand injuries, etc.
Osteoarthritis is a disease in which there is a violation of the processes of formation of normal cartilage tissue in various joints. These processes are disrupted under the influence of some external and internal predisposing factors. They can be permanent joint injuries, prolonged physical activity (at work, at home, when playing sports), heredity, other joint diseases, etc.
The joints of the fingers hurt with this pathology, because in the periarticular (periarticular) inflammation of the tissues occurs, the nerves are affected. A feature of osteoarthritis is the connection between pain and physical activity. Joint pain appears mainly during and / or after severe physical overload and disappears at rest or after rest.
Systemic lupus erythematosus
Systemic lupus erythematosus is an autoimmune disease in which the immune system produces autoimmune antibodies that attack various structures of cells and tissues. In particular, it produces so-called antinuclear antibodies that damage cell nuclei and DNA and RNA molecules. With lupus erythematosus, various tissues and organs are affected: skin, blood vessels, heart, pleura, pericardium, kidneys, joints, etc.
Systemic lupus erythematosus is constantly associated with other extra-articular signs - weakness, weight loss, fever (increase in body temperature). However, the most important are special symptoms, without which the diagnosis of lupus erythematosus is not made. These special signs are photodermatitis (inflammation of the skin caused by sunlight), discoid eruption (the appearance on the skin of the neck, on the chest of red papules), lupoid butterfly (the appearance of red spots on the skin near the nose), oral erosion, kidney damage (glomerulonephritis), serositis (inflammation of the serous membranes) and so on.
Diagnosis of the causes of pain in the joints of the hand
Diagnosis and treatment of the causes of pain in the hand joints are mainly taken care of by a traumatologist and a rheumatologist. To diagnose such causes, these doctors mainly use clinics (taking anamnesis, external examination, palpation, etc.), radius (radiography, computed tomography) and laboratory (general blood test, biochemical blood test, etc.) research methods.
Depending on the cause of pain in the joints of the hand, all diagnostics can be divided into the following sections:
- diagnostics of traumatic injuries of the hand (bruises, dislocations, fractures, ligament damage);
- rheumatoid arthritis diagnosis;
- diagnosis of Kienbeck's disease;
- diagnostics of reactive arthritis;
- diagnosis of gout;
- diagnosis of psoriatic arthritis;
- diagnostics of synovitis;
- diagnosis of osteoarthritis;
- diagnosis of systemic lupus erythematosus.
Diagnosis of traumatic hand injuries
In case of hand injuries, you should consult a traumatologist. The main diagnostic methods used in medical practice to identify traumatic injuries of the hand (fractures, dislocations, ligament injuries, bruises), are external examinations, anamnesis, radiation research methods (radiography, computed tomography).
Collecting anamnestic data allows doctors to identify accidents that have led or may have caused hand injuries. In addition, the history collection is used to clarify the symptoms that bother the patient. An external examination of the hand can detect edema, hematoma, its deformation, limitation of joint mobility. With the help of palpation, the doctor reveals the presence of pain, a violation of the anatomical shape of the joint, damage to the ligaments. Beam Search Methods (radiography, computed tomography) allow to confirm the diagnosis, since mechanical damage to the anatomical structures of the hand is clearly visible during use.
Treatment of diseases that cause inflammation of the joints of the hand
To treat the causes of pain in the joints of the hand and fingers, doctors, first of all, prescribe a variety of drugs (anti-inflammatories, pain relievers, antirheumatic drugs, etc.). In some cases, the use of these funds is combined with physiotherapy procedures. Traumatic hand injuries are most often treated surgically or a plaster cast is placed on the affected upper limb.
To relieve pain and relieve inflammation, first aid may be the use of external NSAIDs. The drug selectively blocks COX-2 and acts directly on the source of pain. It absorbs quickly thanks to its special texture, leaves no marks on clothes and has a pleasant smell.
Depending on the pathology that causes inflammation of the joints of the hand, the whole treatment can be divided into the following parts:
- treatment of traumatic hand injuries (bruises, dislocations, fractures, ligament damage);
- treatment of rheumatoid arthritis;
- treatment of Kienbeck's disease;
- treat reactive arthritis;
- treat gout;
- treatment of psoriatic arthritis;
- treatment of synovitis;
- treatment of arthrosis;
- treatment of systemic lupus erythematosus.