Why does it occur?
The pathology i.e. the abnormality is dependent on what is swollen as noted above. There can be many causes including congenital (at birth), developmental (occurring during growth), injury (trauma), infection, arthritis, tumours (typically benign but rarely sinister) and inflammatory e.g. rheumatoid arthritis.
What happens if nothing is done?
(This is referred to as the natural history i.e. what happens if Nature runs its own course). Some people’s symptoms resolve especially if the underlying cause also settles. Some patients however progress and become increasingly intrusive.
Making the diagnosis
The Hand specialist who sees the patient will ask questions about their symptoms, when they started, how they progressed, what treatment (if any) they have had and other questions relevant to the problems. They will then examine the patient looking at the wrists and hands. Stressing i.e. pushing on the affected area is usually painful. It is necessary to demonstrate some tenderness to confirm the site of the symptoms but this should not be too painful.
What test(s) might be performed?
Tests (also known medically as Investigations) include X-rays, scans, blood tests and particularly in the hand electrical tests (known as EMGs or Neurophysiology). These may be used to help make or confirm a diagnosis after a patient has described their symptoms and been examined.
The diagnosis is usually obvious after listening to and examining a patient. Typically an X-ray is requested on the same day to delineate the extent of joint damage, although the X-ray findings do not correlate well with the symptoms with some patients having few X-ray changes but marked symptoms and vice versa.
Sometimes an MRI scan will be necessary to look at the soft tissue or a CT scan may be requested to delineate bone abnormalities.
An MRI scanner is usually a short tunnel which the patient’s arms and top half of the body go into. Usually the arms are stretched out in a “superman” pose which is a little uncomfortable but generally well tolerated. Once in the tunnel a loud magnet is spun around and images of the bones and soft tissues created. Some people find the tunnel rather claustrophobic. If any patient doubts whether they would tolerate the scan they are best advised to visit the scanner department in advance. The films will be reported by a radiologist but also reviewed by the Hand specialist who will advise the patient accordingly.
A CT (or CAT) scanner is a short large open tunnel. The patient lies on a bed and passes through the tunnel whilst X-rays are shone from various directions at the area of the body being investigated. It is particularly useful for showing bone abnormalities but less good at investigating soft tissue problems. The films will be reported by a radiologist but also reviewed by the Hand specialist who will advise the patient accordingly.