The back of the hand, known as the dorsal area, is an intricate network of bones, tendons, and nerves that allows for complex movement and dexterity. Pain in this region is common because these structures are relatively exposed, lying just beneath the skin. Understanding the location of the discomfort—over the knuckles, the wrist, or the hand surface—can often point toward the cause. Pain may stem from an acute impact, repetitive motion damage, or an underlying long-term physical condition.
Sudden Traumatic Injuries
Pain that begins immediately following a specific event is often the result of sudden trauma to the dorsal hand structures. A direct blow frequently causes a metacarpal fracture, a break in one of the five long bones that form the body of the hand. This injury, often called a Boxer’s fracture when it affects the fourth or fifth metacarpal, results in severe, immediate pain and rapid swelling.
Less severe trauma can lead to a ligament sprain, which is damage to the tough tissues connecting bones around the knuckles or wrist joints. A fall onto an outstretched hand can forcefully stretch these ligaments, causing sharp pain upon movement and localized tenderness. Contusions, or simple bruising, occur when blunt force trauma ruptures small blood vessels beneath the skin without breaking a bone.
Pain from Repetitive Strain and Overuse
When pain develops gradually over weeks or months, it is frequently linked to mechanical causes from repeated movements that overload the hand’s soft tissues. The dorsal hand houses the extensor tendons, which originate in the forearm and run across the back of the hand to straighten the fingers and wrist. Repetitive actions can lead to extensor tendinitis, an inflammatory condition characterized by a dull ache and tenderness along these tendons.
Activities requiring consistent finger extension or wrist rotation are common culprits, such as prolonged computer use, heavy manual labor, or playing certain musical instruments. The inflammation can also affect the protective sheath surrounding the tendons, a condition known as tenosynovitis. This results in pain that worsens with movement and may be accompanied by a palpable creaking sensation, called crepitus, as the tendon slides within its irritated sheath.
A specific type of tenosynovitis, De Quervain’s tenosynovitis, affects the tendons on the thumb side of the wrist, causing pain that radiates into the dorsal hand during gripping or pinching movements. This overuse injury is common in new parents who frequently lift and hold their infants. These conditions stem from the accumulation of microtrauma, where tissue wear outpaces the body’s ability to repair the damage.
Chronic Conditions and Structural Causes
Dorsal hand pain can be a manifestation of long-term diseases or structural abnormalities that develop independently of injury or overuse. Arthritis is a frequent cause, with Osteoarthritis (OA) and Rheumatoid Arthritis (RA) presenting differently in the hand joints. OA, or “wear-and-tear” arthritis, typically affects the joints closest to the fingertips or the base of the thumb, causing bony enlargement and pain that is worse with activity.
Rheumatoid Arthritis (RA), an inflammatory autoimmune condition, tends to affect the small joints of the wrist and the knuckles (metacarpophalangeal joints) symmetrically. This pain is often accompanied by prolonged morning stiffness and may cause significant swelling and warmth over the dorsal hand. The persistent inflammation in RA can eventually lead to joint erosion and visible deformity.
Another common structural cause is a Ganglion Cyst, the most frequent soft tissue mass found on the hand. These non-cancerous, fluid-filled sacs most often appear on the back of the wrist, arising from a joint capsule or tendon sheath. While many are painless, they can cause a constant, dull ache or sharp pain if they press on a nearby nerve. Nerve compression or entrapment, such as that affecting a branch of the radial nerve, can also cause pain, numbness, or a burning sensation.
Knowing When to See a Doctor
While many causes of dorsal hand pain can be managed with rest and anti-inflammatory medication, certain symptoms require prompt medical evaluation. You should seek immediate attention if the pain follows a severe trauma, if you have a visible deformity, or if you completely lose the ability to move your fingers or wrist. These signs suggest a potential fracture, a severe ligament tear, or a significant tendon injury.
A consultation is also warranted for pain that persists or worsens despite two weeks of rest and basic home care. Other concerning signs include any signs of infection, such as fever, chills, spreading redness, or pus draining from a wound. Any new or worsening numbness, tingling, or noticeable loss of grip strength should be evaluated to rule out nerve compression or a progressive underlying condition.