Hand pain
in Rockhampton

What is going on

Pain in the fingers and palm has more variety of cause than the wrist or elbow because the hand has so many small joints, tendons, pulleys and skin spaces. But despite the variety, most hand pain sorts itself into a small number of clearly recognisable patterns — what the finger does when it hurts (catches, droops, bends, stiffens) is usually a better guide to the diagnosis than where the pain is.

The five patterns below describe what the patient notices first. Each has a characteristic story, examination signature and treatment pathway. The thumb is covered separately on the thumb pain hub, and wrist-side conditions (carpal tunnel, de Quervain's, post-fall presentations) on the wrist pain hub.

Other causes to mention

A small number of hand-pain presentations don't fit the five-pattern set above. These are less common as the lead complaint but worth knowing about — particularly because they have their own management pathways.

• Hand lumps and bumps

  A lump in the hand that isn't part of the patterns above — a flexor tendon sheath ganglion in the palm at the base of a finger, a mucous cyst at a DIP joint, or a giant cell tumour of the tendon sheath (a benign but mechanically symptomatic soft-tissue mass). Each has a characteristic location, growth pattern and treatment pathway. The consult sorts which lump is which on examination and imaging.

  Flexor sheath ganglion →

• Finger fracture or fingertip injury

  Acute trauma — a crushed or jammed finger, a deep cut, a nail-bed laceration. Most settle with splinting, buddy strapping or wound care; the small subset that need surgery (displaced fractures, rotational deformity, complex nail-bed injury, exposed bone) benefit from early specialist assessment. Tetanus status and clean wound management are the universal early steps.

  Finger fractures →

• Boutonniere or swan-neck deformity

  Chronic finger deformities that follow a missed or untreated tendon injury or develop in inflammatory arthritis. The boutonniere pattern — PIP flexion with DIP hyperextension — follows a central slip injury that was not splinted in extension acutely. Swan-neck is the opposite pattern. Both are sorted on examination; treatment depends on flexibility of the deformity and the joints involved.

  Boutonniere deformity →

How a hand consult works

The first consult takes 30–40 minutes. It runs through a structured history (when, what made it worse, where exactly, what makes it better, any sudden injury, any mechanical symptoms), a focused examination of each finger joint, the flexor and extensor tendons, the palmar fascia, the intrinsic muscles, and a review of any imaging you bring. The consult ends with a diagnosis (or a clear plan to confirm it) and an itemised treatment plan — splinting, injection, further imaging, or surgery — written for the GP.

Hand therapy is coordinated on-site through Ruby Doolan's practice (Extend Rehabilitation), which keeps post-consult, post-injection and post-operative therapy in one place. The fees, Medicare rebates and quote process are on the fees page; GPs can find the referral pathway and urgency triage on the referrer page.

Patient questions we hear most

• How do I know if my hand pain needs surgery?

  Most hand pain doesn't need surgery. Trigger finger commonly settles with a single corticosteroid injection; mallet finger settles in a DIP-extension splint for the great majority of patients; DIP and PIP arthritis settles into a manageable end state with splinting, injection and activity modification. The conditions that more often need surgery are progressive Dupuytren's contractures (typically when the MCP flexion gets past 30° or the PIP joint becomes involved), displaced finger fractures, suspected hand infections (urgent drainage), bony mallet fingers with large fragments, and end-stage joint arthritis. The first job at consult is establishing the diagnosis — that determines the pathway.

• My finger is hot, swollen and throbbing — how urgently do I need to be seen?

  Same day, or via emergency presentation if Dr Hirpara's rooms can't see you the same day. Hand infections — paronychia, felon, flexor tenosynovitis, deep palmar space infections — deteriorate over hours rather than days. Untreated infections can cause stiff fingers, tendon necrosis, sepsis, and rarely amputation. Animal bites and human bites carry a particularly high infection rate. The threshold for early assessment is low: red streaks tracking up the hand, increasing pain that wakes you at night, a finger held semi-flexed because passive extension hurts (the flexor tenosynovitis pattern), or any rapidly increasing swelling all warrant urgent review.

• My finger keeps locking when I bend it — is that a tendon problem?

  Yes — that's the classic trigger finger pattern. The flexor tendon thickens at its sheath, the A1 pulley narrows, and the tendon catches as it passes through. The pop, click or sudden lock is the tendon snapping past the pulley. There's usually a tender nodule at the base of the affected finger on the palmar side. Most cases settle with a single corticosteroid injection, sometimes a second; the proportion that don't are candidates for surgical release of the A1 pulley, a small day-case operation. Diabetics tend to respond less well to injection and more often need surgery.

• My fingertip won't straighten after I caught a ball — what is it?

  That's almost certainly a mallet finger — a rupture of the terminal extensor tendon at the very end joint of the finger. The mechanism is sudden forced flexion of an extended fingertip (a ball hits the end of the finger, the bedsheet catches, the finger jams against a furniture corner). An X-ray is needed early to identify the small minority that have a large bony avulsion needing surgical fixation. The rest are managed in a DIP-extension splint, worn continuously day and night for 6–8 weeks. The splint protocol is more demanding than most patients expect — taking it off for showering can reset the clock if the DIP joint flexes during the change. The earlier the splint goes on after the injury, the better the outcome.

• I have a bent finger that's getting worse — is it Dupuytren's?

  Possibly. Dupuytren's contracture is the slow, painless thickening of the palmar fascia into a nodule and then a cord that pulls the finger into flexion — most commonly the ring and little fingers, in northern European men over 50, often with a family history. The diagnosis is made on examination — a palpable cord that runs from the palm into the digit. The tabletop test (can you lay your hand flat on a table?) tracks progression and is used to time intervention. Treatment is generally offered when the contracture interferes with hand function, not before. The options — needle fasciotomy, collagenase injection, open fasciectomy — each have a role; the consult discusses which fits the cord pattern, joint involvement and recurrence history.

• Should I see my GP first or come straight to a specialist?

  GP referral is needed for a Medicare rebate, so the GP visit comes first regardless. The GP can also organise initial imaging (X-ray for any post-trauma finger pain or fingertip droop) and start antibiotics if a hand infection is suspected. Acute presentations — a fingertip that won't straighten, a deep cut, a hot swollen finger, a finger fracture with deformity — are best seen the same week (or same day for infections) and most GPs will refer urgently. Slow-onset patterns — trigger finger, Dupuytren's, finger-joint arthritis — are the typical specialist referral pattern.