Hand, Wrist & Elbow Conditions and Injuries

Painful fingers, hands, wrists, forearms and elbows.

That’s what I treat every day in clinic, and that’s what this section covers. Each article tells you what the condition actually is, why it happens, what recovery looks like week by week, and the point where it stops being something you can wait out.

This page is the overview: the conditions I see most, how each one typically behaves, and the full index of everything this site covers.

If you don’t yet know what you have, start with Where does your hand hurt?

It sorts you by the exact spot that hurts and what it does, and sends you to the right article. If you’d rather understand the machinery first, start with how the tendons in your hand work, the eight bones in your wrist or the nerve map of your hand.

The 3 to 7 day rule

Most minor hand and wrist pain settles within 3 to 7 days. A wrist you strained in one heavy gym session. A jammed finger that still bends all the way. A sore elbow after a weekend of DIY. Rest it, protect it, and your body does the rest.

Past that window, different story. Tendons thicken where they rub. Joints stiffen in whatever position you’ve been guarding them in. Then your other fingers start helping out, then the wrist, then the shoulder, and now you have compensation problems stacked on top of the original one.

I see this every week.

Someone comes in at month three with a finger that locks. At week two, a splint would have settled it. Now we’re talking injection, sometimes surgery. Not because they were careless. Because waiting felt reasonable, and nobody told them their condition wouldn’t wait with them.

So the rule I give patients: pain that’s clearly improving by day 7, let it finish healing. Pain that’s the same or worse at day 7, get it looked at. You lose nothing by being assessed early. You can lose a lot by being assessed late. If yours started in the last few days, what to do in the first 72 hours sets out what to rest, what to keep moving, and how to read day 7.

One exception, and it matters: infections don’t get the 7 days. Anything red, hot, spreading or badly swollen runs on hours, not days. That section is below.

Red flags that skip the waiting rule entirely

Some signs mean get assessed now, not at day 7.

Numbness or pins and needles that don’t pass.
A finger you cannot straighten or bend, even gently, with your other hand helping.
A joint that looks bent, rotated or shortened compared with the same finger on the other hand.
Pain in the wrist below the thumb after a fall, even if the X-ray “looked fine”, because a scaphoid fracture hides from first X-rays and a missed one can kill the bone’s blood supply.
A cut over a finger or palm where anything afterwards feels weak. Any fingertip that’s white, blue or cold.
A finger that has been pulled by a ring, whatever the skin looks like.
Pain after an injury that is far worse than the injury looks, especially in the forearm, which can be compartment syndrome.
And redness spreading up the hand or forearm, with or without fever, especially after a cut, a scratch or a bite.

None of these are wait-and-see problems.

The conditions I see most

Trigger finger

A flexor tendon catches on the first pulley at the base of the finger, the A1 pulley, because the tendon or its sheath has thickened. Early on it’s a click and some morning stiffness. Later the finger locks in a bent position and has to be pulled straight with the other hand.

Caught early, a small splint worn at night and some activity changes settle a large share of cases in about 6 weeks. Once it’s locking daily, you’re usually looking at a steroid injection, and long-standing locked fingers end up in surgery. The gap between those outcomes is mostly time.

Read the full trigger finger article here, and if you want to know whether yours is still at the stage where it can be settled without surgery, that question has its own page.

The splint is the most underused treatment in this condition and the detail that makes it work is which joint it holds — see the trigger finger splint and exercises. The thumb version behaves a little differently and has its own page here.

De Quervain’s tenosynovitis

Pain on the thumb side of the wrist, worst when you lift something with your thumb pointing up, a kettle, a pan, a baby.

The two tendons that pull the thumb out are inflamed in their shared tunnel. I see it in new parents so often it has a nickname, mummy wrist, and it also loves phone-heavy thumbs. A thumb spica splint plus load changes does the early work; the stubborn ones need an injection.

Read the full De Quervain’s article here, and the home treatment and exercises separately — including why the test everyone reproduces at home is not a stretch.

Carpal tunnel syndrome

Numbness and tingling in the thumb, index and middle fingers, classically waking you at night and easing when you shake the hand out. The median nerve is being compressed in its tunnel at the wrist. Night splints help early cases genuinely well.

What worries me is the late ones:

constant numbness and a flattening of the muscle pad below the thumb mean the nerve is dying, and a nerve that’s been compressed too long doesn’t fully come back even after surgery.
Tingling that comes and goes is a warning. Numbness that stays is a deadline.

Read the full carpal tunnel article here.

For the self-management side, which exercises help and which make it worse is its own article, and if the symptoms are mainly at night, hands numb at night reads the pattern finger by finger.

The version that starts in pregnancy follows different rules and usually has a different ending.

Tennis elbow and golfer’s elbow

Tennis elbow is pain on the outer bony point of the elbow, golfer’s on the inner.

Neither needs the sport.

Both are overload of the tendons that anchor your gripping and wrist muscles, which is why shaking hands, lifting a mug or wringing a towel can hurt at the elbow. These are slow conditions in both directions: months to build, and typically 6 to 12 months to fully settle even with good rehab.

Rest alone rarely fixes them, because the tendon needs graded loading to rebuild, not just absence of use. Read the full tennis elbow article here and the golfer’s elbow article here, and the loading programs that actually rebuild the tendon in tennis elbow exercises and golfer’s elbow exercises.

Mallet finger

A ball hits the fingertip, the tip droops, and you can’t straighten the last joint on its own. The thin tendon that lifts the fingertip has torn, sometimes pulling a fragment of bone with it. Treatment sounds easy and isn’t: a small splint holding the tip dead straight, worn continuously for 6 to 8 weeks.

Continuously means continuously. Let the tip bend once at week 4, even for a second while washing, and the healing tendon pulls apart and the clock restarts. I tell patients this on day one because the splint is simple and the discipline is the actual treatment.

Read the full mallet finger article here.

Arthritis in the hand

Osteoarthritis in the hand is not random: it goes for the last joint of the finger, the middle joint, and the base of the thumb, and it usually spares the knuckles. That distribution is most of the diagnosis, and the outcome is far more changeable than people are told, because most of the disability comes from stiffness and grip habits rather than the cartilage itself.

Read the full hand osteoarthritis article here, along with the specific pages on finger joints and the thumb base — where stability work and joint protection do more than anything else available.

The immune-driven versions run on completely different clocks:

rheumatoid takes the knuckles of both hands symmetrically, while
psoriatic arthritis takes the end joints rheumatoid spares, swells whole fingers, and pits the nails

Rheumatoid arthritis in the hands

The one condition here where the hand is the early warning system for the whole body.

Swelling across the knuckles of both hands, morning stiffness that runs longer than an hour, and fatigue that doesn’t match what you did yesterday. Unlike osteoarthritis, this one is driven by an immune process, and the joint damage it causes is largely preventable if treatment starts early.

That window is measured in months, not years, which is why I never tell a patient with both hands swollen to wait and see. Read the full rheumatoid arthritis article here, and if you are trying to work out which kind you have, how long the morning stiffness lasts separates them faster than anything else.

Wrist fractures

The distal radius fracture, a fall onto the outstretched hand, is the one I rehabilitate most.

Whether treated in a cast or with a plate, the fracture itself usually knits in about 6 weeks. The recovery is what happens after: a wrist that’s been still for 6 weeks is stiff, weak and often frightened of load. Weeks 6 to 12 are where outcomes are actually decided, and they’re exactly the weeks many people are discharged into with a sheet of exercises and no follow-up — the exercises for those weeks are set out in full.

Full function takes months, and that’s normal, not a sign something went wrong. One late complication worth knowing about: weeks or months after a wrist fracture the thumb can quietly stop lifting off a flat table, which is a ruptured EPL tendon, not weakness, and no amount of exercise brings it back.

Read the full wrist fracture recovery article here.

Scaphoid fractures

Small bone, big consequences.

The scaphoid sits below the thumb side of the wrist and its blood supply enters backwards, from the far end, so a fracture can starve part of the bone. It’s also famous for hiding on the first X-ray. The pattern I warn every patient about: fall, sore wrist, normal X-ray, told it’s a sprain, pain fades, and months later the wrist aches because the bone never actually healed.

A fall followed by tenderness in the hollow at the base of the thumb needs either repeat imaging in 10 to 14 days or a scan, full stop. Left alone, this and a torn scapholunate ligament are the two things that turn into wrist arthritis in someone’s forties.

Read the full scaphoid fracture article here.

Hand infections

The only group on this site that runs on hours. A hand is a bad place to be infected: tendons, joints and sheaths sit millimeters under the skin with poor blood supply and no room to swell. Where the swelling sits tells you what it is. At the nail fold or in the fingertip pad, it’s a paronychia or a felon, and one of those needs draining rather than waiting.

Spread evenly along the whole finger, with severe pain on straightening, it’s a flexor tendon sheath infection, and that’s a surgical emergency tonight. Spreading redness in the skin is cellulitis, and infection inside a single joint is septic arthritis — the difference being whether the finger will still move.

And the wound that started it is often too small to remember, which is why bites, puncture wounds and ordinary-looking cuts get underestimated so consistently. One caution in the other direction: a single red hot joint isn’t automatically infection. Gout looks identical, and nobody separates them by eye.

Broken, crushed and burned hands

The commonest injuries in this section, and the ones where a small detail decides the outcome.

With a broken finger, the check that matters isn’t on the X-ray at all: make a fist and see whether the finger crosses its neighbor, because rotation is the one deformity a finger can’t work around. With a fingertip crushed in a door, the fracture heals itself and it’s the nail bed underneath that has a deadline — and the nail itself takes six months to tell you the result.

A chip off the front of the middle joint looks like an ordinary jam and quietly destroys the joint over about six weeks. A break at the base of the thumb has a muscle actively pulling it apart, so it rarely stays put in a cast. And if part of a finger has actually been lost, what you do in the first hour decides what’s possible afterwards, with replantation rehab deciding whether a reattached digit actually works.

Where a whole hand has been crushed, the bones are usually the least of it: how long the swelling stays is what decides how stiff the hand ends up. And with a burn, the burn is the short story and the contracture is the long one.

The forearm, where a lot of hand and elbow pain actually starts

Nearly every muscle that moves your fingers and wrist begins in the forearm, and all three nerves to the hand pass through it.

So the forearm is where problems get blamed on somewhere else. Tennis elbow that never responded to months of good treatment can be radial tunnel syndrome. Carpal tunnel symptoms with a numb palm as well as numb fingers can be pronator teres syndrome, and operating on the wrong one leaves you with a scar and the same symptoms.

Numbness on the back of the thumb after a tight watch strap or a cast is a squashed sensory nerve, not carpal tunnel. Weakness with no numbness at all points at the purely motor nerve branches, and there’s a two-second test for each.

Forearms that pump up and stop working have a diagnosis decided by timing rather than location. And after a forearm fracture, the number that predicts how the arm works is rotation, not the X-ray.

When the problem isn’t in your hand at all

A meaningful share of numb hands are not hand problems, and the giveaway is usually how far the symptoms reach.

A stripe of pain running down the whole arm, changing with how you hold your head, is a nerve root in the neck rather than a tunnel in the wrist — and a nerve pinched in two places at once is why some carpal tunnel releases disappoint. Symptoms that get worse with your arms above your head, with the arm fatiguing rather than simply aching, point at thoracic outlet syndrome, where the compression happens before the nerves have even reached the arm.

And numbness in both hands, symmetrical, in a glove pattern that ignores the nerve map entirely, is a peripheral neuropathy — which almost always started in the feet, and needs blood tests rather than a wrist scan. Knowing which nerve owns which finger is what separates all of these in about a minute.

Elbow fractures, ruptures and tendon pain

The elbow is three joints inside one capsule, and it stiffens faster than any other joint in the arm, so the theme running through all of these is moving early rather than protecting.

A fall onto the outstretched hand most often breaks the radial head, and that one can hide behind a normal-looking X-ray. A fall straight onto the point of the elbow breaks the olecranon, where the question that decides surgery is whether you can straighten the arm yourself.

A pop at the front of the elbow while lifting something heavy is a distal biceps rupture, which is the one with a repair window measured in weeks and an arm that carries on working well enough to talk you out of going. Pain on the point of the elbow that only shows up when you PUSH is triceps tendinopathy, routinely mislabelled as the bursa sitting on top of it.

And an elbow that catches, clunks or won’t straighten with no injury behind it is usually elbow osteoarthritis, where the loose fragment is often the thing causing the symptoms.

Symptoms that don’t have a name yet

Plenty of people arrive with a symptom rather than a diagnosis, and a few of those symptoms carry more information than any single test.

Hands that go numb in bed tell you which nerve by which fingers are involved, and whether the back of the hand is affected.
Morning stiffness separates wear from inflammation by how long it lasts and whether both hands are involved.
A grip that has quietly weakened has three possible causes, and the one with no pain attached is the urgent one.
A clicking wrist means nothing without pain, and quite a lot with it.
And thumb pain from phone use is a load problem wearing the name of a condition.

Sports and overuse injuries

A large part of my caseload, and the part where the diagnosis is most often missed, because the sport gives everyone an easy explanation.

Numb hands on the bike get written off as normal cycling, when they’re a nerve being crushed at the wrist.
A pop while crimping is a pulley injury with a grade that decides the next six months.
A golf club catching the turf can break the hook of the hamate, a fracture routine X-rays miss almost every time.
Rowers and lifters get intersection syndrome and have it treated as De Quervain’s, and racquet players get an ECU tendon that snaps out of its groove.
Boxers who keep punching through a sore knuckle can tear the sling that holds the tendon on top of it, which has a window of a few weeks before splinting stops working.
In growing athletes (kids) the weak link is always the growth plate, whether that’s a young thrower’s elbow or a gymnast’s wrist, while in adult throwers it’s the ligament.

The common thread: these get called soreness, and soreness doesn’t get imaged. If you know which sport is causing yours, the sport-by-sport section further down is the faster way in.

Lumps, bumps and color changes

Most lumps on a hand are harmless, and the useful question is almost never whether it’s sinister but which structure it’s growing out of. A soft lump that shifts and changes size is usually a ganglion, either on the back of the wrist or, much more painfully, as a hard little seed in the palm at the base of a finger — and whether yours needs treating at all is usually answered no.

A hard one on the back of the wrist that doesn’t move at all is more likely a carpal boss, which is bone, not fluid. A small cyst at the last joint of a finger that leaves a groove running down the nail is a mucous cyst, and the nail ridge is the tell. A firm lump that never changes size and never goes away is more likely a giant cell tumor of the tendon sheath, which is benign despite the name.

And a hollow found inside the bone on an X-ray, often after a finger broke far too easily, is usually an enchondroma. Color carries its own information. Fingers that go dead white, then blue, then red in the cold are Raynaud’s. The same pattern in the hand that grips a vibrating tool all day is hand-arm vibration syndrome, which is an occupational injury with a legal dimension.

And a mechanic or carpenter who uses the heel of the palm as a hammer can damage the artery underneath it, which is hypothenar hammer syndrome, one of the few hand conditions where the fingertip itself is at risk.

Tendon and nerve injuries

A cut across the palm side of a finger or wrist can divide the cords that bend your fingers or feel the world, and a cut flexor tendon does not heal on its own — the muscle pulls the end back up the finger, and the good repair window is about a fortnight.

Repaired flexor tendons are then the most protocol-driven rehab in hand therapy: the repair is weakest around week 3, right when it’s starting to feel fine, which is precisely when a moment of normal use can snap it. Read the full flexor tendon repair article here.

On the back of the finger the picture is the opposite — extensor injuries look minor, are usually splinted rather than operated on, and quietly produce a permanently bent finger when the deadline is missed; the surgical version is extensor tendon repair.

Nerves are the slow ones: they regrow at roughly a millimeter a day, so sensation returning over months, with tingling marching slowly down the finger, is the system working, not failing. And where a nerve or its muscle is beyond repair, a tendon transfer borrows a working muscle to do the job instead.

Recovery after surgery

Half of what I do is the weeks after an operation, and it’s the part patients are least prepared for.

A few principles run through nearly all of it. Metalwork is usually there to allow early movement rather than to make something immediately strong, which is why a plated wrist gets moved early and loaded late. Nerve operations relieve pressure rather than repairing anything, so symptoms return in a predictable order and strength comes back last and least reliably.

Bone needs blood as much as it needs stability, which is why a fixed scaphoid is checked on CT rather than X-ray. And with tendon problems, the operation removes the bad tissue but only loading builds the good tissue, so the rehab afterwards looks a lot like the treatment that came before it.

Then there are the operations that change what a joint can do rather than repair it, and that trade is the whole conversation beforehand. A finger joint replacement buys movement and pain relief. It does not buy grip strength, and people who go in expecting a stronger hand come out disappointed by a result that technically worked.

A fusion does the opposite: it takes the movement permanently and hands back a joint that stops hurting. Keyhole surgery on the wrist sits in between, and after a TFCC repair the restriction that decides your result is rotation, not the two small scars you can see.

A removed ganglion can grow back, which blindsides people who were told it was a simple day case. And after an elbow release for stiffness, the range you have at six weeks is roughly the range you keep. That one is the least optional rehab on this list.

Whichever operation you had, the scar itself is also on a clock: it stays changeable for roughly six months, and then it stops.

Sport, work and the instrument in your hands

Most hand injuries arrive attached to an activity, and knowing the activity narrows the list fast.

Pickleball produces a pattern nothing else does, because a short stiff paddle makes the wrist do the arm’s job and because going backwards for a lob is how players end up in fracture clinic.
Golf damages the lead wrist, and the injury it hides best is a hook of hamate fracture from one heavy shot.
Tennis, badminton and squash each load a different tissue: the elbow, the wrist, and whatever hits the wall.
Gym and weightlifting wrist pain comes from three loaded positions rather than three exercises, and in powerlifting each of the three lifts produces its own injury — including the mixed-grip biceps rupture that costs people a year.
Hyrox is different again, because an hour of holding on is a fatigue problem rather than a load problem, and CrossFit asks the hands to hang, grip and absorb friction in the same hour.
Yoga asks for extension range most people don’t have yet.
Ball sports generate the most under-treated injury in sport, the finger that was “just jammed”, and rugby and goalkeeping produce it at volume.
Boxing and MMA break hands through repeated impact, and the wrap matters more for the wrist than the knuckles, while in grappling the fingers are the weapon and the target at once.
Climbers get a medial elbow, a brachialis nobody names, and a lumbrical tear routinely called a pulley injury.
And three groups who aren’t athletes take the same kind of load:
- gamers, whose tissue has no idea it’s a game,
- musicians, where almost everything is a practice-volume problem except the one that doesn’t hurt at all, and
- anyone at a keyboard and mouse all day, where the hours do what the sport does.

The jobs that cost people their hands

Some trades are simply harder on hands than others, and the people in them present later than anyone else because stopping mid-shift is not an option.

Nurses and healthcare workers combine force, repetition and twelve-hour shifts, and normalize night numbness for years.
Dentists, tattoo artists and nail technicians all live on sustained precision pinch, which is the most expensive grip there is.
Hairdressers and barbers lose thumbs to scissors, and the single best intervention is a different pair.
Kitchen work produces two separate problems: the cut that happens in a second and the overuse that builds across a season, and meat processing adds cold to the same picture.
Trades using power tools face the one exposure on this site that does not fully reverse, which is why the tingling stage matters more than the white-finger stage.
And massage and manual therapists lose their thumbs first, predictably, usually years before they admit it.
Off the clock, the same pattern appears in gardening, where the season does the damage in one weekend, and in knitting, crochet and sewing, where a finished project is usually the thing that hurt you.

Looking after it yourself

Four questions come up in clinic more than any diagnosis.

Which splint, and crucially when to stop wearing it, because a splint worn for months costs you strength.
Which exercises actually matter, which is four of them rather than a page of twenty, done in short bursts many times a day.
Whether to use ice or heat — ice to settle, heat to move, neither for a nerve.
And when to go back to work, which is a question about specific tasks rather than a yes or no verdict.

For the first few days of a new problem, the first 72 hours covers the sequence. If you’re wondering whether any of it needs a professional, here’s what a hand therapist actually does, and when you genuinely don’t need one.

The full index: every condition this site covers

This is the complete map of finger, hand, wrist, forearm and elbow conditions, injuries and post-surgery diagnoses I treat and write about. Every entry below is a full article with symptoms, recovery timeline, and the week-by-week detail.

Finger and thumb

Hand and palm

Wrist

Forearm

Elbow

When the problem comes from elsewhere

Recovery after surgery

Treatment, rehab and self-management

Splints

By sport and training

By work

Musicians

Hobbies and crafts

Everyday life, devices and mobility aids

Anatomy: how the hand actually works

How to use this section

Find the condition closest to your symptoms and start with the recovery timeline. If you’re not sure which condition that is, sort yourself by where it hurts first. Check yourself against the red flags above. If your pain is already past the 7 day mark and not clearly improving, read the article, then get assessed in person. A website can explain what’s happening in your hand. It can’t examine you. I wish it could, it would save everyone a lot of 2am googling, but it can’t.

Every article here is written by me, Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here.