What are the treatment options for wrist and hand pain caused by computer overuse?

Treatment for Wrist and Hand Pain from Computer Overuse

For computer-related wrist and hand pain, begin with conservative management including education on ergonomic principles, activity pacing, assistive devices, hand exercises, and topical NSAIDs as first-line pharmacological treatment, reserving oral NSAIDs for limited duration when topical agents are insufficient. 1

Initial Clinical Approach

Non-Pharmacological Management (First-Line)

• Education and ergonomic training should be offered to every patient with hand and wrist pain, focusing on proper workstation setup, activity pacing, and use of assistive devices 1
• Exercises to improve function and muscle strength while reducing pain should be considered for all patients, as these provide both symptomatic relief and functional improvement 1
• Orthoses (splints) should be considered for symptom relief, particularly for thumb base involvement, with long-term use advocated when beneficial 1

Common Ergonomic Deficiencies to Address

Computer overuse commonly causes tendinitis, tenosynovitis, and nerve compression syndromes affecting the median, ulnar, and superficial radial nerves 2. Key ergonomic factors that contribute to symptoms include:

• Lack of forearm support (associated with wrist/hand pain) 3
• Absence of wrist support (linked to elbow pain) 3
• Poor chair adjustment (contributes to arm and lower back pain) 3
• Improper keyboard positioning 3

Pharmacological Management

Topical Treatments (Preferred First-Line)

• Topical NSAIDs are the first pharmacological treatment of choice due to superior safety profile compared to systemic medications 1
• Topical treatments are preferred over systemic options specifically because of safety considerations 1

Oral Medications (Second-Line)

• Oral analgesics, particularly NSAIDs, should be considered for limited duration when topical agents provide insufficient relief 1
• The emphasis on "limited duration" is critical to minimize systemic side effects 1

Alternative Pharmacological Option

• Chondroitin sulfate may be used for pain relief and improvement in functioning in patients with hand osteoarthritis, though this applies more to degenerative changes than acute overuse 1

Diagnostic Imaging When Indicated

Initial Imaging

• Radiography (X-ray) is the appropriate initial imaging study for chronic hand or wrist pain, including three standard views: posteroanterior, lateral, and oblique 1
• Radiographs can identify fractures, arthritis, anatomical variants, and other structural abnormalities that may contribute to symptoms 4

Advanced Imaging for Persistent Symptoms

When radiographs are normal or nonspecific and symptoms persist:

• Ultrasound or MRI without IV contrast are equivalent appropriate options for evaluating tendon injury, tenosynovitis, or tendon pathology 1
• Ultrasound is particularly useful for carpal tunnel syndrome, measuring median nerve cross-sectional area and identifying nerve compression 4
• MRI without IV contrast can diagnose tendinopathy, tendon tears, intersection syndrome, tenosynovitis, and stenosing tenosynovitis 1

Treatment Escalation

When Conservative Management Fails

• Rest with splinting, icing, and NSAIDs are indicated in acute cases of overuse tendinitis 2
• Surgical decompression is indicated in chronic or recurrent cases that fail conservative management 2

Treatments to Avoid

• Do NOT use conventional or biological disease-modifying antirheumatic drugs for hand osteoarthritis or overuse syndromes 1
• Intra-articular glucocorticoid injections should not generally be used in hand osteoarthritis, though may be considered for painful interphalangeal joints in select cases 1

Key Clinical Pitfalls

Duration of computer use matters: Studies show that more than 4 hours per day of computer use is associated with increased risk of arm-wrist-hand symptoms (RR 1.9) and neck-shoulder symptoms when using a mouse for more than 4 hours daily (RR 1.5) 5. However, self-reported duration may overestimate risk compared to objective measurements 5.

Common symptom patterns: Upper back pain (69.6%), neck pain (65.2%), and lower back pain (64.1%) are the most frequent complaints in computer users, with 60.5% reporting pain onset after starting computer-intensive work 6. Wrist pain specifically affects approximately 30% of office computer users 7.

Multidisciplinary approach: Optimal management usually requires combining non-pharmacological modalities with pharmacological options when needed, though surgery should be reserved for structural abnormalities when other treatments have failed 1.