Where Does Your Hand Hurt?

Point at the Spot. I’ll Tell You What Usually Lives There.

I’m Nigel Chua, a hand occupational therapist in practice since 2005. Tens of thousands of painful fingers, hands, wrists, forearms and elbows assessed and treated: sports injuries, overuse, fractures, recovery after surgery.

In clinic, the first useful question isn’t what happened. It’s where exactly does it hurt, and what does it do.

Because hands are small and crowded, one centimetre changes the diagnosis. Pain on the thumb side of the wrist and pain on the little-finger side are two completely different problems with two completely different timelines.

So use one finger of your other hand and press around until you find the worst spot. Then find that spot below.

(This narrows it down. It doesn’t diagnose you. Nothing typed on a screen can replace someone putting their hands on yours.)

First: the things that skip the queue

Stop reading and get assessed today if any of these are true:

Numbness that has stopped coming and going and is now constant.
A finger you cannot straighten or bend, even when you help it with your other hand.
A finger that looks bent, twisted or crossed over its neighbour compared with the other hand.
Wrist pain in the hollow at the base of your thumb after a fall, even if an X-ray was called normal.
A fingertip that is white, blue or cold.
Redness spreading up the hand or forearm, with fever, especially after a cut, bite or scratch.

Everything else, keep reading.

The wrist

Thumb side of the wrist

Pain roughly two finger-widths above the base of the thumb, worst when you lift a kettle, a pan or a baby with the thumb pointing up. Tuck your thumb into your fist and bend the wrist towards the little finger. Sharp pain there points at De Quervain’s tenosynovitis.

Pain lower down, in the small hollow right at the base of the thumb, after any fall onto the hand: treat that as a scaphoid fracture until imaging says otherwise. This one hides on first X-rays and gets called a sprain.

Pain at the joint where the thumb meets the wrist, with a grinding feeling opening jars or turning keys, usually past 45: thumb base (CMC) arthritis.

Little-finger side of the wrist

Pain that bites when you rotate the forearm, push up out of a chair, or turn a doorknob, sometimes with a click: TFCC injury.

Numbness or tingling in the ring and little fingers, with the back of the hand feeling completely normal: Guyon’s canal syndrome. If the back of the hand is numb too, the problem is at the elbow, not the wrist. See cubital tunnel syndrome.

Deep pain in the heel of the palm, after a golf club caught the turf or a bat or racquet handle took an impact, with a normal X-ray: hook of hamate fracture. Routine wrist films miss this one.

Middle of the back of the wrist

A deep ache right in the centre after a fall onto the outstretched hand, that never quite settled, with a tender spot just past the end of the forearm bone: consider a scapholunate ligament injury. This is the wrist sprain that wasn’t.

A smooth, firm lump that changes size over months: wrist ganglion cyst.

General soreness after one heavy session, improving day by day: probably a wrist sprain, and that article tells you which ones aren’t.

The whole wrist, after a fall

Swelling, bruising and a wrist you don’t want to move after landing on your hand: distal radius fracture. That article covers the part nobody prepares you for, which is weeks 6 to 12 after the cast comes off.

Front of the wrist, into the hand

Numbness and tingling in the thumb, index and middle fingers, worst at night, easing when you shake the hand out: carpal tunnel syndrome.

The hand and palm

A knuckle that has sunk or disappeared after punching something solid: boxer’s fracture. Check whether that finger crosses over its neighbour when you make a loose fist, because rotation matters more than the X-ray looks like it should.

A firm cord or lump in the palm, usually towards the ring and little finger, slowly pulling a finger down towards the palm: Dupuytren’s contracture. It doesn’t usually hurt, which is exactly why people leave it.

Hands that go numb on the bike and clear up afterwards: cycling hand numbness, also called handlebar palsy. Which fingers go numb tells you which nerve, and the fix is mostly load and position.

Swelling across both hands, stiffness that lasts more than an hour every morning, and fatigue: rheumatoid arthritis. Both hands is the word that matters there.

Pain, swelling, colour changes and skin sensitivity that are clearly out of proportion to the original injury, and getting worse rather than better: read about CRPS today, not next month.

The fingers and thumb

Sorted by what the finger does

Clicks, catches or locks bent, worst in the morning: trigger finger.
Tip droops and won’t straighten after a ball or knock: mallet finger.
Tip won’t bend, after gripping a shirt or jersey and feeling something give: jersey finger. This one has a surgical clock on it.
Middle joint won’t straighten, and it got worse over one to three weeks, not immediately: boutonnière deformity. The delay is the trap.
Popped while crimping, pain at the base of the finger: climbing pulley injury, usually the A2.
Jammed at the tip, swollen, but still bends and straightens: jammed finger.
Middle joint fat, stiff and still swollen weeks later: PIP sprain and finger dislocation.
Thumb painful and unstable at its base after a fall with a pole or a ski strap: skier’s thumb.
Knobbly, bony swellings at the end joints, aching, gradual over years: finger osteoarthritis.

The elbow

Pain on the outer bony point, worst gripping, shaking hands or lifting a mug: tennis elbow. You don’t need to play tennis.

Pain on the inner bony point, worst gripping and wringing: golfer’s elbow.

A soft, squashy lump on the pointy tip of the elbow that looks worse than it feels: olecranon bursitis. Usually harmless, but check it isn’t hot, red or painful first.

Tingling into the ring and little fingers after the elbow has been bent a while, on the phone or asleep: cubital tunnel syndrome.

An elbow that came out of joint, went back in, and now won’t fully straighten: elbow dislocation and the stiff elbow after. The elbow stiffens faster than any other joint in the arm, and the first six weeks decide most of it.

If you’ve already had surgery

Different question entirely. You’re not trying to find out what it is, you’re trying to find out whether what you’re feeling at week 3 is normal.

Still not sure

Two reasons that happens, and they need opposite responses.

Either your symptoms sit across several of these, which usually means one problem is causing the others and you need someone to work out which came first.

Or the pain isn’t in a spot you can point at, which in the hand is meaningful in itself. Nerve problems and referred pain from the neck both do that.

Pain you can point at with one finger has a structure under it. Pain you have to describe with your whole hand usually doesn’t.

Either way, the browse-everything version is here: the full conditions index. And if you’d rather understand the machinery before the diagnosis, start with the anatomy section.

Why this site exists

Most of my patients found their diagnosis the same way. Awake at 2am, hand aching, googling. What they found was either too vague to act on or scary enough to make everything feel worse. So they waited.

Waiting felt reasonable. And by the time they reached a clinic, a problem a simple splint would have settled in two weeks now needed an injection. Sometimes an operation.

Most minor hand and wrist pain settles on its own in 3 to 7 days. Past that, most hand conditions degrade rather than resolve. Knowing which one you have is the whole game, and it’s what every article here is built to tell you.

Written by Nigel Chua, hand occupational therapist in practice since 2005. My credentials are here, and the longer story is here. This page narrows the field; it doesn’t examine you. Pain that isn’t clearly improving by day 7 needs assessing.