Hand pain can make it difficult, if not impossible, to turn the key in your front door, twist off the gas cap before filling up your car, slice vegetables for the evening meal, read a book before going to bed, or send a text to a family member or friend.
Unfortunately, hand pain is common in older age and often underlies decreased grip strength and limitations in your ability to carry out simple, yet vital, activities of daily living like dressing, eating, and toileting.
Arthritis is a common cause of hand pain in older adults, but it is by no means the only problem that can impact your hand function. Here are some common hand pain causes, along with strategies that can help bring hand pain relief.
Hand Pain Due to Fractures
A fall is a common cause of hand pain, since it is reflexive to put your hands out in an attempt to prevent more serious injuries. Falls onto an outstretched hand are one of the most common causes of fractures to the bones that form the wrists, hands, and fingers. Such fractures typically result in pain radiating from the break throughout the hand to the tips of the fingers. The injury also results in swelling and may cause tingling and numbness in the fingers. Fractured fingers may appear shorter than usual and/or the knuckle may be depressed inward.
“Being able to use your hands after bracing against the impact doesn’t mean that you escaped injury,” warns David C. Thomas, MD, MS, MHPE, professor of rehabilitation and physical medicine at Mount Sinai. “Many people are still able to move their wrists and fingers even though they have sustained fractures.”
Hand and wrist fractures are confirmed with a physical exam and x-rays. Treatment of the injury may involve manipulating the bones back into their correct position (you may need a local or general anesthetic).
“You likely will need to wear a splint or cast to restrict movement in the injured hand or wrist, but your doctor may recommend you carefully move uninjured fingers several times a day to prevent stiffening,” says Dr. Thomas. “In some cases, you may need surgery to stabilize the fracture with wires, pins, plates, and screws.”
Over-the-counter (OTC) painkillers can provide hand pain relief if you have a fracture—choose acetaminophen (Tylenol) over nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), since NSAIDs raise the risk of bleeding in older adults.
Dr. Thomas emphasizes that any fall should be reported to your primary care doctor, even if it seemed minor and you apparently did not sustain any injuries. “Falls are a leading cause of serious injury in older adults, as well as being a risk factor for subsequent falls that may be avoided by having your doctor carry out a fall risk assessment,” he notes.
The American Geriatrics Society recommends older adults undergo such assessments each year, and studies suggest they can reduce the risk of falls. During the assessment, your doctor will ask about previous falls and the circumstances in which they occurred (for example, where you were, what you were doing, what type of shoes you were wearing), review your medications to see if any are known to increase the risk of falls, and evaluate your strength and how steadily you walk. Your doctor also may arrange for an occupational therapist to assess any tripping hazards in your home (for example, throw rugs, loose extension cords and poor lighting) and recommend strategies to reduce your risk of falling.
Hand Pain from Sprains
Wrist sprains also can result from falls and are common in people whose recreational activities include pickleball and other popular sports. “A sprain is an injury to a ligament, which is one of the fibrous bands of tissue that connect the bones in a joint,” Dr. Thomas explains. “Sprains in the wrist and forearm can cause mild to more severe hand pain, swelling, and bruising.”
If you think you have sustained a wrist sprain, get it checked out by your doctor to ensure there is no underlying fracture. “If the bones are intact, your doctor likely will recommend you manage your injury through simple, conservative treatments, like resting the joint and applying cold packs for 10 to 15 minutes several times a day,” says Dr. Thomas. “At night, place your hand on a pillow, since elevating it will help reduce any swelling. Use acetaminophen if you need relief from hand pain caused by the injury. If necessary, your doctor will recommend you wear a temporary splint to support a sprained wrist. Severe sprains may require surgery to repair a torn ligament or reattach it to the bone.”
Arthritis-Related Hand Pain
The most common type of arthritis in older adults is osteoarthritis (OA), a disease characterized by degeneration of the cartilage that cushions the bones in a joint. OA mainly affects larger joints like the knees, hips, and shoulders. However, it can develop in the hands, where it mainly affects the base of the thumbs and the joints nearest to the fingertips.
Rheumatoid arthritis (RA) is less common and is an autoimmune disease in which inflammatory substances produced by the immune system attack the synovium (joint lining). The most common location for RA-related hand pain are the joints at the base and middle of the fingers. The wrist also may be affected by RA.
Hand pain is a major symptom of arthritis, and the condition also causes swelling and stiffness. Dr. Thomas says you may gain relief by using simple self-help strategies like alternating ice and heat packs, along with complementary approaches like acupuncture and massage. “Your doctor also may recommend you wear an overnight splint to reduce movement in the affected joint,” he adds.
Use caution with OTC painkillers. If your doctor prescribes stronger pain-relieving medications, be sure to carefully follow dosage instructions. People with hand pain due to RA can gain relief from prescription disease-modifying antirheumatic drugs (DMARDs) like methotrexate (Otrexup, Rasuvo), which slow the course of RA. Biologic drugs are another prescription-only option for more severe RA—examples include etanercept (Enbrel), infliximab, Remicade), and adalimumab (Humira).
If conservative therapies and medications are not sufficient to relieve hand pain from arthritis, cortisone injections can be administered into the affected joints. “While this can provide relief for several months, cortisone cannot be used too often, since it as it can weaken tissue,” Dr. Thomas cautions.
If you regularly experience arthritis-related hand pain, ask your doctor to refer you to an occupational therapist who can prescribe exercises that will help improve flexibility in your hands without aggravating your arthritis. “An occupational therapist also can analyze how you tend to use your hands and advise you on strategies that can reduce the stress on your arthritic joints,” Dr. Thomas adds.
Nerve-Related Hand Pain
Carpal tunnel syndrome (CTS) is a common condition affecting the median nerve, which is responsible for sensations felt by the thumb, the index and middle fingers, and part of the ring finger and controls some of the muscles at the base of the thumb.
“The median nerve runs through the carpal tunnel, a narrow passageway located on the inner side of the wrist and formed by the wrist bones and the transverse carpal ligament,” Dr. Thomas explains. “It is possible for the nerve to be squeezed by tissue that is swollen due to arthritis or by bones that have been fractured in a fall or sports injury. The symptoms include burning hand pain, numbness, and tingling in the thumb and fingers that receive sensory information from the median nerve.”
Mild-to-moderate CTS hand pain may be managed by wearing a brace to immobilize your hand and wrist while you sleep, using cold packs to reduce swelling in the soft tissue adjacent to the median nerve, and taking painkilling drugs as needed.
But if these approaches are not effective and your hand pain becomes severe, surgery may be an option. This carpal tunnel release surgery increases the space within the carpal tunnel by cutting the carpal ligament.
“The increased space relieves the pressure on the median nerve,” Dr. Thomas says. “The carpal ligament fuses back together over time, but this healing process preserves the increased space that was created. After the surgery, you will be referred for occupational therapy to help you regain full use of your hand.”
