miércoles, 31 de octubre de 2018

Hand Pain Management

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By Yolanda Smith, B.Pharm.Reviewed by Liji Thomas, MD

The appropriate management of hand pain will usually depend greatly on the cause of the pain. Management techniques include physical therapy, at-home treatment, medications and surgery, each of which is described in more detail below.

Hand Pain. Copyright: puhhha / Shutterstock

Physical Therapy

For hand pain involving inflammation, the RICE protocol is most beneficial to reduce the swelling and pain. This comprises the four steps. Rest, Ice, Compression, and Elevation. It is important to avoid moving the hand too much. Applying ice may help to reduce swelling. Keep the hand elevated and wrap it to prevent further swelling. This is also beneficial.

A physiotherapist can help patients with hand pain by recommending exercises that strengthen the hand and arm muscles, which provide support to the hand.

If hand pain is caused by a fracture or injury to the hand, it may be necessary to use a cast or other protection to restrict wrist movement while the hand heals.

At Home Treatment

If an injury or other condition is causing inflammation of the hands, it is recommended to remove any jewelry or watches from the fingers and wrist as soon as possible. This is because it can become more difficult to remove these items when the swelling is greatest, that too when it may lead to worsening of pain.

The hands should be protected from extremely cold temperatures by staying inside in winter or wearing gloves when going outside. It is also best to avoid sleeping on the hands, as this can decrease the blood flow to the hand and worsen pain.

Medications

Simple analgesic medications such as acetaminophen (paracetamol) or aspirin are often useful in the relief of hand pain. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, ketoprofen or naproxen can also be useful. Many of these medications are commonly available over-the-counter at a pharmacy without a prescription from a doctor.

In some cases, corticosteroid medications such as cortisone may also be recommended. This helps to control inflammation that is linked to hand pain and can be administered by an injection to the localized site of pain.

For inflammatory conditions such as rheumatoid arthritis or lupus, disease modifying anti-rheumatic drugs (DMARDs) can help to modify the course of the disease and slow the worsening of pain. Biologic response modifiers is another class of medications that can also help to relieve hand pain associated with inflammatory conditions.

For hand pain caused by gout, preventative medication such as allopurinol to reduce the concentration of uric acid in the blood can help to prevent painful attacks of gout in the future.

Surgery

In rare cases, surgery may be required to manage hand pain.

For example, wrist fusion is a procedure that involves the removal of joint surfaces that are affected by inflammation, with the bones then being joined together with plates or screws to encourage bone regrowth and fusion.

A wrist replacement may also be indicated to replace a wrist joint with severe inflammation or damage. This can usually be performed in an outpatient setting and allows patients to retain some movement in their wrist after the procedure.

Finger or thumb joint fusion or replacement procedures are also an option in the management of hand pain. This is similar to the process for wrist fusion or replacement but involves the finger joints instead of the wrist.

Carpal tunnel release is another surgical procedure that involves detachment of the carpal ligament from the median nerve. This procedure may be indicated for hand pain caused by carpal tunnel syndrome.