Treatment for Wrist and Hand Pain from Computer Overuse

Initial Clinical Approach

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, as recommended by the European League Against Rheumatism 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, according to the European League Against Rheumatism 1
Orthoses (splints) should be considered for symptom relief, particularly for thumb base involvement, with long-term use advocated when beneficial, as suggested by the European League Against Rheumatism 1

Topical NSAIDs are the first pharmacological treatment of choice due to superior safety profile compared to systemic medications, as recommended by the American College of Rheumatology 1
Oral analgesics, particularly NSAIDs, should be considered for limited duration when topical agents provide insufficient relief, according to the American College of Rheumatology 1
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, as suggested by the American College of Rheumatology 1

Radiography (X-ray) is the appropriate initial imaging study for chronic hand or wrist pain, including three standard views: posteroanterior, lateral, and oblique, as recommended by the American College of Radiology 2, 3
Ultrasound or MRI without IV contrast are equivalent appropriate options for evaluating tendon injury, tenosynovitis, or tendon pathology, according to the American College of Radiology 2, 5
Ultrasound is particularly useful for carpal tunnel syndrome, measuring median nerve cross-sectional area and identifying nerve compression, as suggested by the American College of Radiology 4
MRI without IV contrast can diagnose tendinopathy, tendon tears, intersection syndrome, tenosynovitis, and stenosing tenosynovitis, according to the American College of Radiology 2, 5

Do NOT use conventional or biological disease-modifying antirheumatic drugs for hand osteoarthritis or overuse syndromes, as recommended by the European League Against Rheumatism 1
Intra-articular glucocorticoid injections should not generally be used in hand osteoarthritis, though may be considered for painful interphalangeal joints in select cases, according to the European League Against Rheumatism 1
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, as suggested by the European League Against Rheumatism 1