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hand pain in the morning

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when I wake in the morning I have troble closing my hands and it is very painful when I try to close them this started near the end of march I went to my hand doctor and she said it is carpal tunnel and I have the pain in my hands when I wake up she has me to sleep in a hand rists but is not working so what do I do now
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replied June 14th, 2011
Especially eHealthy
denisebthd,

Classically, carpal tunnel syndrome (CTS) presents with numbness and tingling in the fingers innervated by the median nerve; the thumb, index finger, middle finger, and half of the ring finger. It is caused by compression of the median nerve within the carpal tunnel at the base of the palm. The numbness and tingling can be brought on by activities with static grasping such as holding a phone for a long time, grasping the steering wheel tightly, using a computer mouse, or a frying pan. Working with instruments that vibrate at work or that need strong grasp such a pliers or wrenches can also bring on the symptoms.

As the disorder progresses, and the nerve becomes more ischemic, the patient develops a dull, deep, aching type pain in the hand. Sometimes, the pain will radiate into the forearm or even the shoulder. Another classic symptom is being awakened from sleep by the pain.

As the disorder progresses even further the symptoms become persistent, with the numbness and tingling being there at all times. Atrophy of the thumb muscles is one of the last signs/symptoms.

Use of night splints in CTS is only to keep the wrist in a neutral position while you sleep. When we sleep, we tend to bring our hands up to our chin, so the wrists get flexed down. This compresses the nerve in the carpal tunnel, causing the fingers to go to sleep.


As you note, except for the numbness in the fingers, they really aren't involved in CTS. It seems that lately, physicians are either so busy, or not interested in listening to their patients, and any disorder in the hand is just called CTS, without really examining the patient or thinking about the problem.

You do not say if you have any swelling associated with the pain.

It is normal for some people to have some diffuse swelling in the fingers in the morning, as the bodily fluids redistribute throughout the body at night. Fluids that have been in the lower extremities during the day (due to gravity), get shifted to the hands, small of the back, and even the face sometimes (puffy eyes).

But, diffuse swelling in the fingers can also be abnormal. It can be seen in disorders like tenosynovitis of the tendons and their sheaths. This can be painful and feel like trying to bend a hot dog in the morning. As the swelling gets pushed out of the finger and the tendons get moving, the hand starts to feel a little better.

If the swelling is limited to the joints of the fingers, then you are usually looking at some type of arthritic condition. Osteoarthritis tends to be better after rest and gets worse with activity. Inflammatory arthritis is the opposite, they feel worse after rest and get better with activity.


An evaluation of the hands should be able to tell if someone has CTS; by doing a carpal compression test, Phalen's test, Tinel's, and 2 point discrimination. Palpation of the flexor tendon sheath, to see if there are any nodules in them. Palpation of the joints to see if they are tender, if there is any fluid within the joints. Is there any redness around the hand or joints? What is the range of motion of the joints, both passive and active? Are the pulses in the hand normal? Is the skin warm or cool, moist or dry?

Also, a set of plain x-rays of the hands could rule out, or diagnosis, a bunch of hand disorders. It's a simple study to complete and interpret.

So, you can see that from the history and a competent exam, most diagnoses can be made. You need to return to the hand surgeon (or see another one) and discuss that the wrist splints are not working. Ask what this could be, since it doesn't seem to be CTS?

Hope you find out what is going on with your fingers. Good luck.
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replied January 7th, 2014
Painful hands when closing when I awake in the morning
Can fibromyalgia cause the painful hands that Denise above is describing? I am having the same problem and I have fibromyalgia and am wondering if it is related. Thank you.
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