Hand Pain: When to See a Rehabilitation or Orthopedic Specialist

Hand pain

Hello, Director Hsu.
I have been experiencing this phenomenon for over a month.
I have seen a neurologist and undergone electromyography.
The doctor mentioned that there is no significant nerve compression, so I was prescribed anti-inflammatory medication and steroids.
However, after two weeks, there has been no improvement.
Could you please advise whether I should see a rehabilitation specialist or an orthopedic doctor? My symptoms include difficulty in tightly gripping with my left hand, particularly with my ring and little fingers.
When I make a fist, there is about a pencil's width of space remaining, and I experience pain only in the joint areas when I grip tightly.
Additionally, I feel pain when I stretch my fingers out to their maximum.
I am unclear about which condition this might be related to.
Thank you very much for your help.

Mr. Huang, 30~39 year old female. Ask Date: 2006/01/16

Dr. Xu Zhenrong reply Rehabilitation

Dear Mr.
Huang,
According to your letter, you are experiencing pain in the fourth and fifth fingers of your left hand, which prevents you from fully gripping or extending them.
The possible considerations include: 1.
Neurological issues, 2.
Muscular issues (tendons or ligaments), and 3.
Other conditions (such as rheumatic or autoimmune diseases).

From a neurological standpoint, the fourth and fifth fingers may indicate ulnar nerve pathology or cervical radiculopathy.
However, since you have already undergone electromyography and nerve conduction studies, these conditions have been ruled out.
Therefore, we should consider whether there are issues related to muscles or ligaments.
Additionally, some rheumatic and autoimmune diseases often present with stiffness, swelling, or pain in the small joints of the fingers, so this should also be taken into account.
For a more definitive diagnosis, you may want to consult with a neurologist, a rehabilitation specialist, or an orthopedic surgeon.
Wishing you a speedy recovery.
Sincerely,
Hsu Chen-Jung
Taipei Hospital, Ministry of Health and Welfare

Reply Date: 2006/01/16

More Info

When experiencing persistent hand pain, especially when it affects your ability to grip or perform daily activities, it is crucial to seek appropriate medical evaluation and treatment. Given your symptoms of weakness in the left hand, particularly in the ring and little fingers, along with pain during gripping and stretching, it is essential to consider a few factors before deciding whether to consult a rehabilitation specialist or an orthopedic surgeon.

Firstly, your symptoms suggest a possible issue with the ulnar nerve, which innervates the ring and little fingers. Ulnar nerve entrapment, commonly known as cubital tunnel syndrome, can lead to weakness and pain in these fingers, especially when the elbow is bent. The fact that you have already seen a neurologist and undergone electromyography (EMG) testing, which did not show significant nerve compression, is a positive step. However, if your symptoms persist despite anti-inflammatory medications and corticosteroids, further evaluation is warranted.

In this scenario, consulting a rehabilitation specialist would be beneficial. Rehabilitation specialists can provide a comprehensive assessment of your hand function and may recommend physical therapy to improve strength, flexibility, and overall function. They can also guide you through specific exercises designed to alleviate pain and enhance mobility in your fingers and hand. Additionally, they may employ modalities such as ultrasound therapy, electrical stimulation, or manual therapy techniques to address pain and improve function.

On the other hand, if the rehabilitation approach does not yield significant improvement, or if your symptoms worsen, it may be necessary to consult an orthopedic surgeon. Orthopedic specialists can evaluate structural issues in the hand, wrist, and elbow that may contribute to your symptoms. They may recommend imaging studies, such as X-rays or MRIs, to assess for any underlying conditions, such as ligament injuries, fractures, or joint issues that could be causing your pain and functional limitations.

It is also important to consider the duration and severity of your symptoms. If you have been experiencing these issues for over a month without improvement, it is reasonable to pursue further evaluation. Early intervention can often lead to better outcomes, especially in cases involving nerve-related issues or musculoskeletal injuries.

In summary, given your current symptoms and the lack of improvement with medication, I recommend starting with a rehabilitation specialist. They can provide targeted therapy to address your specific needs and help you regain function in your hand. If you do not see progress after a reasonable period of rehabilitation, do not hesitate to seek an orthopedic evaluation to rule out any structural problems that may require surgical intervention. Remember, effective communication with your healthcare providers about your symptoms and concerns is key to finding the right treatment plan for your condition.

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