Pain guide
Most wrist and hand pain can be eased at home, and where it hurts is the best first clue. The NHS gives the same first steps for most of it: rest the activity that brings it on for a few days, use a cold pack, try painkillers or ibuprofen gel, wear a splint at night if it helps, and keep the hand moving gently. See a GP if it hasn't improved after 2 weeks.
Start with the warning signs below, then find your pain on the map. If it fits a clear pattern, go to that guide. If you're not sure, follow the plan on this page from stage 1. For some of these problems, exercise is a helper rather than the main treatment, and the guides say so.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Often waking you at night and eased by shaking the hand; worse with bent-wrist or gripping tasks. Later the thumb can feel weak and you may drop things. The pattern of carpal tunnel syndrome.
Read: Carpal tunnel syndrome →Thumb side of the wrist, worse moving the thumb or grippingWorse wringing a cloth or lifting a baby or a kettle with your thumbs pointing up, sometimes with swelling over the thumb side of the wrist. Common in pregnancy and the weeks after a birth. Points to de Quervain's tenosynovitis.
Read: De Quervain's tenosynovitis →An ache at the base of the thumb when you pinch, turn a key or open a jarUsually 45 or over, sometimes with a bump where the thumb meets the wrist, and stiffness that eases within 30 minutes of getting up. Points to thumb base arthritis.
Read: Thumb arthritis →Stiff, sore finger joints with bony bumpsBumps on the end or middle finger joints, usually from 45, often in a few joints. Hand osteoarthritis: the pain may settle over time, though the bumps remain.
Read: Hand and finger arthritis →A finger or thumb that clicks, catches or locks bentOften a tender lump in the palm at the base of the finger, worse in the morning; more common over 40 and with diabetes or rheumatoid arthritis. Trigger finger.
Read: Trigger finger →After a fall on an outstretched handPain, swelling or bruising at the wrist: a sprain, or a broken wrist or scaphoid. Tenderness in the hollow at the base of the thumb after a fall needs an X-ray and follow-up, even if the wrist moves. Check the warning signs first.
Read: Wrist sprain or fracture →Wrist ache only in push-ups, planks, downward dog or front squatsIt settles with rest and comes back with the position: load-related wrist pain. Change the position first, then build back up.
Read: Wrist pain in push-ups and yoga →Doors, keys, a racquet or push-ups bring it on, sometimes with clicking. Several structures sit here, including the TFCC (a cushion of cartilage and ligament), and their signs overlap. See the note on little-finger-side pain below.
Stiff for well over 30 minutes in the morning, perhaps tired, feverish or losing weight, or unable to make a full fist. This can be rheumatoid arthritis: see a GP soon, because NICE asks for urgent referral.
Often a ganglion cyst. It can come and go and may ache after use, and most go on their own. See the note on ganglions below.
Brought on by phone calls, driving or sleeping with the elbow bent, often with an ache on the inside of the elbow. Usually the ulnar nerve at the elbow (cubital tunnel syndrome), not carpal tunnel.
Read: Ulnar nerve entrapment →Pain or tingling down one arm into the hand, changed by moving your neckA narrow band of pain from the neck or shoulder blade into the hand, often with neck pain: a pinched nerve in the neck.
Read: Pinched nerve in the neck →Buttons and handwriting get harder over months, usually from 50. Pressure on the spinal cord in the neck can do this, and it is often first labelled carpal tunnel. Get it checked urgently.
Usually constant: peripheral neuropathy. In the UK, diabetes is the most common cause. See a GP.
With numbness and pins and needles during attacks: Raynaud's. A GP can check it, especially if attacks are severe.
Usually painless and slowly worse over months or years: Dupuytren's contracture. See a GP if you can't put your hand flat.
A painful, swollen fingertip that droops: mallet finger. Get same-day advice from NHS 111.
Tennis elbow: an elbow problem rather than a wrist one.
Read: Tennis elbow →Inner elbow pain, worse gripping or bending the wristGolfer's elbow: an elbow problem rather than a wrist one.
Read: Golfer's elbow →Pain at the front of the elbow, or a stiff, aching elbowElbow problems such as distal biceps tendinopathy or elbow arthritis. The elbow pain guide sorts them.
Read: Elbow pain →The NHS sorts hand pain by where it hurts (wrist, thumb, fingers, palm and back of the hand) and asks people not to diagnose the cause themselves. Use the map to pick a starting point. If your pain doesn't fit, or hasn't improved after 2 weeks of looking after it, get it checked.
Tingling in the hand can start at the wrist, the elbow or the neck, and the pattern is the best clue.
A nerve conduction test is used when the cause is unclear. The US orthopaedic surgeons' guideline says a validated symptom-and-examination score can be used instead of routine nerve tests, and advises against MRI for diagnosing carpal tunnel syndrome.
Many popular beliefs about wrists and hands are weaker than they sound.
Sources 35, 34, 21, 27, 28, 29, 30, 31, 45, 12, 18, 38, 9, 48, 50, 10, 37, 36, 46, 52, 54
A ganglion is a smooth, fluid-filled lump, usually on the back of the wrist or near a finger joint. It is often painless but can ache after use, and it is much more common in women. The NHS says most go without treatment, which can take several months to a year. Don't try to burst one. Ibuprofen and a wrist support or compression wrap can ease the pain.
In one study of 39 untreated palm-side wrist ganglia, 20 had gone by 5 years, and symptoms at 5 years were similar whether a cyst had been removed, drained or left. If you want it treated: draining it often fails (it comes back in about 59%); surgery comes back less often (about 21% after open surgery and 6% after keyhole surgery) but has more complications (about 14% after open surgery).
Exercise doesn't shrink a ganglion; keep the wrist moving within comfort with the wrist and forearm flow. See a GP if the lump grows, is hard or doesn't move, and urgently if it is very painful, hot or red.
Pain on the little-finger side of the wrist is often worse twisting (doors, keys, a racquet), gripping or leaning on the hand, sometimes with clicking. Several structures sit here, including the TFCC (a cushion of cartilage and ligament). The history and examination findings of their problems overlap, which makes the diagnosis hard even for specialists, and no trials of specific exercises for it were found.
A sensible plan while it is irritable (editorial): avoid loaded twisting and leaning on a wrist bent towards the little finger (push-ups, side planks on the hand, a front squat rack position), and keep it moving with the wrist and forearm flow. Then rebuild with light forearm rotations, wrist curls, reverse wrist curls, ball squeezes and carries, and return to push-ups through the stages of the push-up guide.
Get it assessed if it started with a fall or a twist and isn't settling within 2 weeks, if the wrist feels unstable or weak, or if it clicks with pain on every turn.
The NHS describes repetitive strain injury (RSI) as pain from repeated movement. It often gets better on its own. Keep active and don't rest the area for more than a few days, use cold packs and painkillers if they help, and talk to your employer about adjusting your work. Physiotherapy or occupational therapy can help if it doesn't settle.
Computer work hasn't been shown to cause carpal tunnel syndrome. Ergonomic changes (arm supports, special mice, workstation adjustments, sit-stand desks) had inconsistent or no proven benefit for preventing arm and hand symptoms in office workers, while extra short breaks may reduce discomfort a little, on very low-quality evidence.
A practical desk routine (editorial): a break every 30 to 60 minutes with the wrist and forearm flow, the wrist flexor stretch and tendon glides. If tingling is the main symptom, read the carpal tunnel guide.
Rheumatoid arthritis is an autoimmune disease that usually affects the hands, feet and wrists, often on both sides. The joints are painful, swollen, warm and stiff, morning stiffness often lasts much longer than with osteoarthritis, and you may feel tired, feverish or lose weight. Early diagnosis matters, because early treatment prevents joint damage.
NICE asks GPs to refer urgently, even if blood tests are normal, when the small joints of the hands or feet are affected, more than one joint is affected, or symptoms had lasted 3 months or more before you sought advice. NICE also lists carpal tunnel syndrome and tendon rupture as complications that need a surgeon's opinion.
Once your medicines have been stable for at least 3 months, NICE recommends considering a tailored hand exercise programme from a trained therapist. In the SARAH trial of 490 people, such a programme improved hand function by 4.3 points more than usual care at 12 months. This site doesn't give a rheumatoid arthritis plan: ask your rheumatology team before following the hand arthritis exercises.
Carpal tunnel syndrome is more common in pregnancy and often gets better on its own afterwards; a night splint is the usual first step. De Quervain's is linked with pregnancy and the weeks after birth, often starting 4 to 6 weeks after delivery. In one study of 63 women after childbirth, a first baby and a pregnancy longer than 40 weeks were risk factors, but the baby's weight was not.
Lifting with your thumbs pointing up is one of the movements that brings de Quervain's on, so scoop the baby up with your palms up instead (editorial). No source on steroid injections in pregnancy or breastfeeding was checked for this page: ask your midwife, GP or pharmacist.
In 139,691 adults in 17 countries, each 5 kg lower grip strength was linked with a 16% higher risk of death over about 4 years, and grip predicted death better than blood pressure did. Grip is a marker of overall strength and health. No trial has shown that squeezing a grip trainer changes that risk.
For a painful hand, use the graded plan for your condition. For general strength, carries, hangs and curls train grip as part of bigger lifts.
Source 54
The NHS's first steps for wrist, finger and thumb pain: rest the activity that causes it, use a cold pack wrapped in a towel (up to 20 minutes every 2 to 3 hours), try painkillers or ibuprofen gel, wear a splint at night if it helps, and keep the hand moving gently. See a GP if it hasn't improved after 2 weeks, keeps coming back, or comes with tingling, or if you have diabetes. For repetitive strain, the NHS adds: don't rest for more than a few days.
In a Cochrane review of 7 trials (534 people), hand exercise reduced pain by about half a point on a 0 to 10 scale, improved function a little and eased finger stiffness, with few side effects. The effects faded within 6 to 12 months once the programmes ended. NICE, the American College of Rheumatology and the European rheumatology recommendations (EULAR) all recommend exercise for hand osteoarthritis.
In a UK trial of 257 adults with hand osteoarthritis, joint protection teaching from an occupational therapist (spreading loads, bigger grips, gadgets, pacing) made more people better at 6 months: 33% against 21% without it.
Source 41
A Cochrane review of exercise and mobilisation (16 trials) found only limited, very low-quality evidence of benefit. A later meta-analysis of 22 trials found nerve glides improved pain and function a little in the short term, on very low-certainty evidence, and a US guideline found exercise doesn't improve long-term outcomes. Glides are cheap and safe to try alongside a night splint; they are not a reason to delay getting help.
In a trial of 934 people with confirmed carpal tunnel syndrome, starting with surgery led to recovery at 18 months in 61%, against 45% starting with a steroid injection. A Cochrane review found surgery probably leads to more improvement than splinting in the long term, though differences in symptom scores were small. The NHS says surgery usually cures it.
Two large cohorts, in France and the USA, found no link between computer work and new carpal tunnel syndrome; it was far more common in jobs with forceful hand work. A meta-analysis found no clear association either, and the US orthopaedic guideline panel's view is that heavy keyboard use is not associated with it.
The scaphoid, a small bone at the base of the thumb, accounts for about 70% of broken wrist bones and can look normal on the first X-ray. No single examination finding confirms a fracture, though no tenderness in the snuffbox makes one much less likely. NICE suggests considering MRI as the first scan for a suspected scaphoid fracture after a thorough examination.
Neither has good trials of exercise. For de Quervain's, a steroid injection plus a few weeks in a thumb splint has the best support; for trigger finger, a finger splint and steroid injections do. Gentle movement keeps the hand from stiffening while they work.
Some discomfort during these exercises is fine and doesn't mean you are doing damage. Keep it to about 5 out of 10 or less. It should settle within half an hour or so, and your hand should be no worse the next morning. If it is, do fewer, smaller or lighter next time, not nothing. An NHS wrist rehabilitation booklet uses the same limit: an unpleasant stretch of about 5 out of 10 that settles within 30 minutes.
Tingling and numbness are different. With nerve glides, a little extra tingling is expected but should fade within an hour, as an NHS hand-therapy leaflet puts it. Stop and get advice if numbness spreads, lasts, or your grip or thumb gets weaker.
Don't rest the hand completely for long, either: for repetitive strain, the NHS says resting for more than a few days makes the area weaker and less flexible. If a joint becomes hot, red and swollen, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Days 0 to 14. Cut down the task that brings it on (typing, tools, an instrument, heavy gripping) for a few days, then build back. For a recent injury or a hot, swollen area, use a cold pack wrapped in a towel for up to 20 minutes every 2 to 3 hours, and no heat for 2 to 3 days. A splint at night is fine if it helps. Doses are editorial starting points unless a source is named.
3D demoWrist & forearm flowBeginner · No equipment10 slow reps each way, 2 to 3 times a day
Harder: Wrist flexor stretch
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment4 to 6 of each position, 5 s holds · Up to 4 times a day: the dose in an NHS hand-therapy leaflet
Harder: Ball squeeze
Move on when: Daily tasks are getting easier, the pain settles within half an hour of using the hand, and it is no worse the next morning.
About weeks 2 to 6. This follows the order of an NHS wrist rehabilitation programme: moving, then stretching, then weight through the hands, then strengthening.
3D demoWrist flexor stretchBeginner · A wall2 holds of 30 s each side · The hold in an NHS wrist rehab booklet
Easier: Wrist circles · Harder: Quadruped wrist rocks
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box2 sets of 10 · With no weight at first, then a light one
Easier: Wrist-extensor eccentrics · Harder: Dumbbell reverse curl
3D demoBall squeezeBeginner · Other / check instructions10 squeezes, 5 s holds · A soft ball; the hold from the Chartered Society of Physiotherapy's hand squeeze
Harder: Band finger extension
3D demoBand finger extensionBeginner · A band2 sets of 10
Easier: Ball squeeze · Harder: Band overhead triceps extension
3D demoWrist curlsBeginner · A dumbbell1 to 2 sets of 10, every other day · Very light: a tin of beans is enough
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoReverse wrist curlBeginner · A dumbbell + A bench or box1 to 2 sets of 10, every other day · Very light
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoWall push-upBeginner · A wall5 holds of 5 to 10 s · Lean a quarter, then half, three-quarters and all of your weight through your hands, as in the NHS booklet; then do the push-ups
Harder: Push-up
Move on when: The stretch and light weights pass the pain rule, and you can lean your full weight through your hands on a wall.
From about week 6, and ongoing.
3D demoWrist curlsBeginner · A dumbbellUp to 3 sets of 10, every other day · Heavier as it gets easy, as in the NHS booklet
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoReverse wrist curlBeginner · A dumbbell + A bench or boxUp to 3 sets of 10, every other day
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoHammer curlBeginner · A dumbbell2 to 3 sets of 10
Easier: Seated dumbbell curl · Harder: Alternating hammer curl
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m
Harder: Suitcase carry
3D demoQuadruped wrist rocksBeginner · No equipment10 slow rocks in each of 4 hand positions
Easier: Wrist flexor stretch · Harder: Bar hang
3D demoKnee push-upBeginner · No equipment2 to 3 sets of 8 to 12 · Once the incline push-up is easy
Harder: Push-up
3D demoBar hangIntermediate · Pull-up bar + A step3 holds of 10 to 20 s · If you need grip for sport or climbing
Easier: Extended puppy pose (Uttana Shishosana) · Harder: One-arm dead hang
Move on when: Add load one change at a time. Keep two short strength sessions a week going once the pain has gone.
Cut down the task that brings the pain on for a few days, then build back. Resting a repetitive strain for more than a few days makes the area weaker and less flexible, the NHS says.
Before bed, for carpal tunnel: the median nerve glide, tendon glides and the wrist and forearm flow, then put the night splint on.
At a desk: the wrist and forearm flow, the wrist flexor stretch and tendon glides, with a short break every 30 to 60 minutes. Extra short breaks may reduce discomfort a little, on very low-quality evidence; the timing is editorial.
Hold 2 to 3 times for 20 to 30 seconds, a mild stretch, never sharp.
| Stretch | Reasonable for | Take care or skip | Why |
|---|---|---|---|
| Wrist & forearm flow | Nearly everyone, at any stage | None within comfort | Active movement with no load: the first stage of the NHS wrist programme. |
| Wrist extensor stretch (tennis elbow stretch) | Typing ache on the back of the forearm; tennis elbow | De Quervain's: don't tuck the thumb into a fist and tip the wrist towards the little finger, the position doctors use to test for it | Keep the thumb relaxed. The tennis elbow guide uses it alongside strengthening. |
| Wrist circles | Everyone; a warm-up | Keep it gentle in the first 2 to 3 days after a sprain | Active range with no load. |
| Wrist flexor stretch | Desk stiffness; push-up and yoga preparation; about 2 weeks after a cast comes off, once moving freely | Carpal tunnel, if it brings on tingling; the first weeks after a fracture | A held stretch with the wrist bent back, as in NHS rehab. |
| Kneeling Forearm Stretch | People without wrist pain who want a strong stretch | Carpal tunnel, a recent injury or fracture, wrist or thumb arthritis | It puts body weight into a deep wrist bend (editorial). Use the wall version instead. |
| Quadruped wrist rocks | Returning to push-ups and yoga; late sprain rehab | Within 6 weeks of a fracture; tingling in the fingers | Weight through the hands, as in the third stage of the NHS programme. |
| Tendon glides (hand tendon gliding exercises) | Carpal tunnel, trigger finger, hand arthritis, after an injury | A finger that locks: don't force it | Moves each finger tendon through its range. |
| Median nerve glide (six hand positions, for carpal tunnel) | Carpal tunnel | Numbness that spreads or lasts; a weak thumb | Slides the nerve through the carpal tunnel. Very low-certainty evidence of a small effect. |
| Median nerve slider (neck-to-arm nerve glide) | Nerve symptoms that start in the neck or upper arm; carpal tunnel with symptoms above the wrist | The first, most painful days of a pinched nerve | The neck-to-arm glide from the pinched nerve guide. |
| Thumb lifts and O-sign (thumb base exercises) | Thumb base arthritis, including its web-space stretch | De Quervain's early on: use the assisted version (editorial) | Keeps the thumb opening and trains the muscles that steady it. |
| Forearm ball roll | Forearm tightness from gripping | Tingling; rolling over the wrist bones or the inner elbow | For comfort only; no trials. |
Numb, tingling fingers at night? What night splints, nerve glides, injections and surgery do for carpal tunnel, with a staged plan and 3D exercise demos.
Pain guidePain on the thumb side of the wrist, often after a new baby. What helps de Quervain's most, which thumb movements to rest, and a staged plan with 3D demos.
Pain guidePain at the base of the thumb when you pinch, turn a key or open a jar. Thumb exercises from the trials, splints, joint protection, and where surgery fits in.
Pain guideStiff, knobbly finger joints? Hand exercise helps a little and is safe. A trial-based programme with 3D demos, joint protection, and signs it may be RA.
Pain guideA finger or thumb that clicks, catches or locks. What splints, steroid injections and surgery achieve, gentle tendon glides to try, and when to get help.
Pain guideFell on your hand? How to tell a sprain from a break, why a scaphoid fracture can hide on an X-ray, and a staged wrist rehab plan with 3D exercise demos.
Pain guideWrists ache in push-ups, plank or downward dog? Change the position today, then rebuild tolerance with a staged plan, 3D demos and the signs to get checked.
Often because the position loads an irritated wrist: push-ups, planks and downward dog put your body weight through a wrist bent back to around a right angle. If it started with a fall, check the warning signs first. Otherwise, change the position for now (fists, push-up handles or a forearm plank) and build back up; the push-up guide has a plan.
Pain on the little-finger side, worse twisting or leaning on the hand, can come from several structures, including the TFCC, and even specialists find them hard to tell apart. Avoid loaded twisting and leaning on the bent wrist for now, keep it moving, then rebuild. Get it checked if it followed a fall or a twist and isn't settling within 2 weeks, or the wrist feels unstable or weak.
Pain on the thumb side of the wrist that is worse moving the thumb or gripping is often de Quervain's tenosynovitis. An ache at the base of the thumb when you pinch, from about 45, is more often thumb arthritis. After a fall, pain at the base of the thumb can be a broken scaphoid and needs checking.
You often can't tell without an X-ray. Go to A&E if the wrist has changed shape, you heard a snap, or the hand is numb, pale or cold. Get same-day help if it is very painful, very swollen or you can't use it. Tenderness in the hollow at the base of the thumb after a fall needs checking even if the wrist moves.
A splint at night is a standard first step for carpal tunnel, and the NHS suggests one for wrist pain if it helps. After a sprain, a support for the first days is part of the NHS's PRICE advice; then wean off it as you start moving. With de Quervain's, a thumb splint works best alongside an injection. Don't stop using the hand altogether.
Ice, wrapped in a towel, for a recent injury or a hot, swollen area: up to 20 minutes every 2 to 3 hours, and no heat for the first 2 to 3 days after an injury. For arthritis stiffness, the NHS says hot or cold packs help some people, and guidelines suggest whichever eases it.
Typing can make an irritated wrist ache, but computer work has not been shown to cause carpal tunnel syndrome: two large cohorts found no link. Ergonomic keyboards and mice have inconsistent evidence, and extra short breaks may help a little. Keep active and don't rest for more than a few days.
Carpal tunnel syndrome is more common in pregnancy and often gets better after the birth; a night splint is the usual first step. De Quervain's is linked with pregnancy and the weeks after birth, and a thumb splint and lifting with your palms up help. Ask your midwife, GP or pharmacist before any injection or medicine.
It depends on the cause. For hand and thumb arthritis, exercise is a core treatment, though the benefits in trials are small. After a sprain or fracture, staged exercise is how the wrist gets back to full use. For carpal tunnel, de Quervain's and trigger finger, splints, injections and sometimes surgery carry more evidence, and exercise keeps the hand moving alongside them.
Call 999 or go to A&E after an injury if the hand is numb, pale or misshapen or a bone is showing, or for sudden weakness in one arm with a drooping face. Get same-day help for a hot, red, swollen joint or a fever, lost feeling in the hand, or both hands numb and clumsy with unsteady walking. Otherwise see a GP if it isn't better after 2 weeks, you have tingling, or you have diabetes.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
