Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps

Abstract

Background: Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon.

Objective: The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies.

Methods: This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities.

Results: 120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology.

Conclusions: Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.

Keywords: CMC-1-Osteoarthritis; Ganglion; Hand surgery; TFCC tear; Trauma surgery; Wrist pain.

Fig. 1

Documentation sheet (translated to English) utilized for the assessment of pain levels and location of pain

Fig. 2

Exemplary workflow on hand graphics to visualize frequencies of affected areas on one specific patient. Patients mark the location of maximum pain projection on hand graphics. A grid with numbered cells is adapted to the hand-graphic, superimposing the depicted skin surface projection of pain. The cells containing the patient’s mark are recorded in an excel sheet. Images are created by processing and visualizing affected cells using a program written in java 1.7

Fig. 3

Bar graph depicting gender distribution according to the diagnostic groups. Data depicted as absolute and relative frequencies

Fig. 4

Bar graph depicting the distribution of patients’ mean level of stress-induced pain as assessed on a 11-point NRS across the different diagnostic groups. Data depicted as mean (SD)

Fig. 5

Hand graphics (A CMC-1-Osteoarthritis; B Dorsal wrist ganglion; C TFCC tear) with color-coded frequencies of pain projection at the skin surface

Fig. 6

Bar graph depicting clustered results of impairments/limitations in daily activities/functions reported by patients according to the diagnostic groups. Data depicted as absolute frequencies