Where Does Your Hand Hurt? - Hand Pain No More

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 & repetitive strains
tears to muscle, ligaments, cartilage or tendons
fractures that are simple to the downright complex such as fragmentation
recovery after injections or 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, even 2 to 5 millimetres can change the diagnosis entirely. 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 or going for accurate imaging.)

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, scratch or bite.
A whole finger swollen evenly, resting slightly bent, that hurts severely when someone straightens it. That’s a tendon sheath infection, and it goes to hospital tonight.
Any part of a finger cut or torn off. Go now, and read what to do in the first hour on the way.

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 higher up, a hand’s width above the wrist on the back of the forearm, sometimes with a squeak you can feel: intersection syndrome. Same tendons, wrong place, and it gets treated as De Quervain’s constantly.

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. If it followed an injury rather than building over years, consider a fracture at the base of the thumb.

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.

Pain you can trace along a tendon line at the back, or a distinct snap when you turn your palm up: ECU tendinopathy or subluxation. Caught fresh, the snapping version is treated in a cast.

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.

The same deep central ache but with no injury at all, building over months in a younger hand, with a normal X-ray: Kienböck’s disease. This one needs an MRI, not more patience.

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

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.

Aching with load, weakening grip, losing movement, in someone who injured that wrist years or decades ago: wrist arthritis. Usually the ending of a missed ligament tear or a scaphoid that never healed.

A young gymnast, cheerleader or tumbler with back-of-wrist pain when weight-bearing on the hands: gymnast’s wrist. That’s a growth plate, and it gets stopped rather than strapped.

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.
Middle joint dislocated, or still badly swollen and not improving three weeks on: PIP fracture-dislocation. Needs a proper side-on X-ray of that one finger.
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.

If it’s broken or crushed

A broken finger bone: make a fist and check it doesn’t cross its neighbour. Rotation outranks the X-ray.
Fingertip caught in a door or hit with a hammer, nail going black: crushed fingertip. The nail bed is the part with a deadline.
Injury at the very base of the thumb, can’t pinch: Bennett’s or Rolando fracture.

If it’s red, hot or swollen

Different rules apply here. Infections in the hand run on hours, not the 3 to 7 days everything else on this site gets. Where the swelling sits tells you what you’re dealing with.

Beside the nail, red and puffy along the nail fold: paronychia. Often settles early with soaks. Needs draining once pus has collected.
The fingertip pad, tense and throbbing, far more painful than it looks: a felon. Pressure inside a closed compartment. Get it seen and drained.
The whole finger, evenly, resting bent, agony to straighten: flexor tendon sheath infection. Emergency department tonight.
One joint, red hot and untouchable, came on overnight: could be gout, could be a joint infection. Nobody tells those apart by looking, so a first attack gets assessed.
After any bite, however small: bites to the hand. A cat’s puncture and a split knuckle from someone’s tooth are the two that cost fingers.
A soft lump on the point of the elbow that barely hurts: olecranon bursitis. Usually harmless, unless it’s hot and red.

The forearm

Worth checking even when the pain feels like it’s at the elbow or the wrist, because the muscles and nerves that serve your hand all run through here.

Aching outer forearm, treated as tennis elbow for months with no improvement, tender below the bony point rather than on it: radial tunnel syndrome.
Carpal tunnel symptoms, but the palm is numb too and it doesn’t wake you at night: pronator teres syndrome. Worth raising before anyone books a wrist release.
Weakness with no numbness anywhere: AIN or PIN palsy. Try making an OK sign, and try lifting your fingers with your forearm flat on a table.
Forearms that pump up and stop working at the same point in every session: exertional forearm pain. The timing is the diagnosis.
After a broken forearm: forearm fracture recovery. Rotation is the number to chase, not the X-ray.

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.

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

After a fall or a heavy lift

Outer elbow pain after landing on your hand, worst turning your palm over: radial head fracture. Commonest one, and it can hide on the X-ray.
Landed straight on the point of the elbow, and can’t straighten the arm against gravity: olecranon fracture.
A pop at the front of the elbow while lifting or catching something heavy, then bruising down the forearm: distal biceps rupture. There’s a repair window of about two to three weeks.
Came out of joint, went back in, and now won’t fully straighten: elbow dislocation and the stiff elbow after.

If you throw

Adult, inner elbow pain when throwing, velocity or command dropping: thrower’s elbow and the UCL.
Still growing, elbow sore after games: little league elbow. In a child the growth plate fails before the ligament does, so this one gets stopped earlier.

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.