This page was last reviewed 02-07-19
Pain and swelling in the hand may result from recent trauma or inflammatory conditions such as arthritis or tenosynovitis. Examples of the latter include De Quervain’s tenosynovitis, which is associated with pain and swelling around the first dorsal extensor compartment of the wrist, through which the extensor pollicis brevis and abductor pollicis longus tendons pass. The condition produces pain on wrist movements and is associated with a positive Finkelstein’s test. Treatment is usually conservative, incorporating rest, anti-inflammatory medication and splints. Occasionally, steroid injection into the compartment or surgical decompression under local anaesthetic is required.
Ligamentous injury around the wrist can produce intermittent pain, swelling, a clicking sensation and loss of function or strength. It may prove difficult to reach a diagnosis can be difficult necessitating MRI scanning and wrist arthroscopy.
Who to refer:
- Any unexplained symptomatic wrist or hand condition that has not responded to conservative measures or those in whom a trial of conservative management is not deemed appropriate.
Who not to refer:
- Minor recent onset conditions that can be explained though minor injury in whom radiological imaging shows no evidence of a lesion or fracture and in whom a trial of conservative management has yet to be undertaken.
How to refer:
Via SCI gateway to the Hand service at St John’s Hospital with appropriate details and background information.
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