Pain in palm of hand

Pain in the palm of the hand is a common clinical complaint that can result from a wide range of conditions. Accurate evaluation is essential to identify the underlying cause and provide appropriate treatment.

Anatomy of the Palm

Bones and Joints

The palm contains five metacarpal bones that connect the wrist bones to the phalanges of the fingers. Each metacarpal articulates with the proximal phalanges at the metacarpophalangeal (MCP) joints. Interphalangeal joints and carpometacarpal joints contribute to hand mobility and load distribution.

Muscles and Tendons

The intrinsic muscles of the palm, including the thenar and hypothenar muscles, lumbricals, and interossei, facilitate fine motor movements. Flexor tendons pass through fibrous sheaths in the palm to connect forearm muscles to the fingers, enabling flexion and grip strength.

Nerves and Blood Vessels

The median, ulnar, and radial nerves provide sensory and motor innervation to the palm. The superficial and deep palmar arches, formed by the radial and ulnar arteries, supply blood to the hand and fingers. Proper vascular and neural function is essential for hand dexterity and sensation.

Fascia and Connective Tissue

The palmar fascia is a thick, fibrous layer that supports the hand and anchors the skin to underlying structures. This fascia, including the palmar aponeurosis, plays a role in force transmission and may be involved in conditions such as Dupuytren’s contracture.

Etiology of Pain in the Palm

Traumatic Causes

• Fractures of metacarpals or phalanges
• Sprains and strains of ligaments and muscles
• Soft tissue injuries including contusions and lacerations

Inflammatory and Degenerative Causes

• Osteoarthritis or rheumatoid arthritis affecting MCP or interphalangeal joints
• Tendinitis and tenosynovitis of flexor tendons
• Palmar fasciitis and Dupuytren’s contracture

Neurological Causes

• Carpal tunnel syndrome caused by median nerve compression
• Ulnar nerve entrapment at the wrist or elbow
• Peripheral neuropathy due to systemic conditions

Vascular Causes

• Ischemia resulting from arterial compromise
• Raynaud’s phenomenon leading to intermittent pain and color changes

Infectious and Systemic Causes

• Bacterial or viral infections affecting soft tissue or joints
• Systemic diseases such as diabetes or gout causing hand involvement

Clinical Evaluation

History Taking

• Onset, duration, and progression of pain
• Associated symptoms such as numbness, tingling, swelling, or stiffness
• History of trauma, repetitive hand use, or occupational activities
• Previous medical conditions including diabetes, arthritis, or infections

Physical Examination

• Inspection for swelling, erythema, deformities, or nodules
• Palpation to localize tenderness, masses, or joint abnormalities
• Assessment of range of motion in fingers and wrist
• Neurological examination including sensory testing and muscle strength
• Special tests such as Tinel’s sign, Phalen’s test, and Finkelstein’s test to evaluate nerve or tendon involvement

Diagnostic Investigations

Laboratory Tests

• Inflammatory markers including ESR and CRP for inflammatory or infectious causes
• Serum uric acid for suspected gout
• Autoimmune panels such as rheumatoid factor or anti-CCP antibodies for arthritis evaluation

Imaging

• X-ray to detect fractures, joint space narrowing, or bony deformities
• Ultrasound to evaluate tendons, ligaments, and soft tissue structures
• MRI for detailed visualization of soft tissue, nerve compression, and occult injuries
• CT scan in complex fractures or when precise bone detail is needed

Electrodiagnostic Studies

• Nerve conduction studies to assess median or ulnar nerve function
• Electromyography to evaluate muscle involvement and detect neuropathic changes

Management

Conservative Treatment

• Rest and activity modification to reduce strain on the affected palm
• Physical therapy including stretching, strengthening, and range-of-motion exercises
• Splints or orthoses to immobilize the hand and protect injured structures
• Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or short-term corticosteroids to reduce pain and inflammation

Interventional and Surgical Options

• Steroid injections into tendons or joints for persistent inflammation
• Tenosynovectomy or fasciotomy for cases of severe tendon or fascial involvement
• Nerve decompression surgeries for carpal tunnel syndrome or ulnar nerve entrapment
• Fracture fixation or corrective surgery for bone injuries and structural deformities

Prognosis and Complications

Expected Outcomes

Most cases of palm pain respond well to early diagnosis and appropriate management. Conservative treatment often results in full recovery, while surgical intervention may be required in severe or chronic cases. The prognosis depends on the underlying cause, patient compliance, and timely treatment.

Potential Complications if Untreated

• Chronic pain and functional impairment of the hand
• Progressive joint deformities in arthritis or untreated fractures
• Permanent nerve damage in cases of prolonged compression
• Loss of hand strength and dexterity
• Development of contractures in untreated palmar fasciitis or Dupuytren’s disease

Prevention and Patient Education

Ergonomic Modifications

Proper hand positioning during work or daily activities can reduce stress on the palm. Using ergonomic tools, adjusting workstation height, and avoiding repetitive strain can help prevent injury and chronic pain.

Exercise and Stretching Programs

Regular hand and wrist exercises maintain flexibility, strength, and circulation. Stretching the fingers, palm, and wrist can reduce the risk of tendonitis, nerve compression, and joint stiffness.

Early Recognition of Symptoms

Patients should be educated to recognize early signs of palm pain, numbness, or swelling. Prompt evaluation by a healthcare professional can prevent progression to chronic pain, functional impairment, or permanent nerve damage.

References

1. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd edition. London: Elsevier; 2021.
2. Warwick D, Williams PL. Gray’s Anatomy. 36th edition. Philadelphia: Saunders; 1980.
3. Adams BD. Disorders of the Hand. In: Campbell’s Operative Orthopaedics. 14th edition. Philadelphia: Elsevier; 2021. p. 3145–3180.
4. Rempel D, Keir PJ, Bach JM. The biomechanics of the hand. J Hand Ther. 2008;21(2):116–126.
5. Rayan GM. Hand and Upper Extremity Surgery. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2015.
6. American Academy of Orthopaedic Surgeons. Hand and Wrist Injuries. Rosemont, IL: AAOS; 2022.
7. Palmer AK. Hand pain: evaluation and management. Orthop Clin North Am. 1990;21(1):13–25.
8. Graham B, et al. Carpal tunnel syndrome: diagnosis and management. BMJ. 2020;370:m3150.
9. Fowler JR, et al. Dupuytren disease: evaluation and management. J Am Acad Orthop Surg. 2016;24(7):e164–e174.