Hand and wrist disorders: how to manage pain and improve function.

Pain, swelling, or impaired function of the hand or wrist may be the result of one of several chronic or acute conditions, including tendinitis, arthritis, infection, or trauma. The first step in diagnosing a hand or wrist disorder is a detailed history. Include a review of the medical history, as many systemic disorders (eg, psoriasis, diabetes mellitus, rheumatoid arthritis, and scleroderma) may affect the hand and wrist. In the physical exam, assess motions of the cervical spine and those of all joints in the symptomatic extremity. A simple neurologic evaluation is required to assess function of the major nerves in the upper extremity. X-rays are indicated in any patient with hand or wrist pain.