Suffering from Hand or Wrist Pain? Physiotherapy Can Help
Hand and Wrist Pain
The wrist and hand are joints that are often underappreciated for how important they are for day to day tasks! The wrist’s main role is to position the hand. The hand is used for EVERYTHING (work, play, hygiene and leisure)! From highly dexterous tasks (writing, knitting, typing etc) to high power activities (gripping heavy shopping, punching a footy, lifting a couch). The wrist and hand joints work in harmony. The joints are complicated structures comprising many small bones, tendons, ligaments and small muscles and joints.
If you have pain in the wrist or hand, you soon realise how frustrating and debilitating it can be to lose the use of the joints. Activities you previously took for granted soon become tedious and draining.
Wrist and hand injuries can be broken down into overuse or acute trauma injuries.
1. Acute Trauma Injuries
How did I sprain my wrist?
The wrist ligaments are commonly sprained in sport. The most common mechanism is falling forwards or backwards with an outreached hand. The high force impact of your wrist with the ground may cause your wrist to bend further than it normally can, with the stabilising ligaments stretched too far and tearing.
Wrist sprains can also happen in personal training and combat sports where a mistimed punch causes the wrist to go too far in one direction.
If there is increased swelling in the wrist with large pain from a fall, the wrist may be fractured. This would require imaging (usually an x-ray) to confirm the diagnosis, and further medical or surgical management may be warranted.
Fractures may also occur in contact sports if there is direct trauma to the wrist/forearm.
Physiotherapy Treatment for wrist sprains and acute wrist injuries
Treating wrist sprains involves a period of rest, bad sprains may require anti-inflammatories. Braces or taping may help give support initially. When the pain settles and the tissue is safe to move, a progressive mobility and strength program will benefit restoring any deficits.
2. Overuse Hand/Wrist Injuries
Wrist pain can be remarkably common when starting a new activity, performing an exercise with a weight that is too heavy for the wrist, or increasing the frequency of a hand dominant activity.
a)Sporting Overuse Injuries:
Gymnastics, yoga and upper body gym training (think push ups) often require weight bearing through the hand and wrist joint. These activities are deceptively demanding and require good baseline wrist strength. Most people will rarely go into these positions in day to day tasks, our hands are often in the air rather than connected to the ground. The muscles that support your wrist are actually in your forearm. The wrist flexor muscle group needs to be strong to support your wrist when weight bear.
Like other muscles, tendons and joints in the rest of the body, the wrist tissues can easily become overloaded. Weight bearing activities need to be gradually progressed and surrounding muscles need to be strengthened to withstand the demands of the task.
Another population subgroup we often see is in gym training, weightlifting and cross fit training. Athletes need to ‘jerk’ (transitioning to the overhead position in an olympic weightlifting “clean and jerk”), and will increase their front squat training to do so. If their bar holding position is incorrect or they have stiff shoulders/wrists, this will increase the forces into the wrist joint and tendons. This may cause an overuse injury.
b) Occupational Repetitive Strain Injury
Similar to sporting overuse injuries mentioned above, overuse injuries in the wrist may be from an increase in work and occupational loads. We often see new office workers develop wrist pain.
People may be new to full time work or the workforce and be asked to increase their computer activity. The repetitive use of the mouse and keyboard, combined with potentially poor ergonomics (poor desk set up means the wrist is excessively extended or flexed) may induce a Repetitive Strain Injury aka RSI injury.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is one type of RSI injury. On the palm side of your wrist, there is a narrow canal (the carpal tunnel) which allows structures to enter the hand from the forearm. It is surrounded by bones and ligaments.
There are 9 tendons and 1 nerve (the median nerve) that pass through the narrow canal. It is thought that repetitive flexion and extension in the wrist may thicken the sheath around the tendons, which compresses the median nerve.
Symptoms of carpal tunnel are commonly numbness, tingling or burning in the thumb, 2nd and 3rd fingers. Discomfort is generally worse in the morning or late at night. Weakness and muscle wastage of the thumb muscles may occur if the condition is untreated for a long period. There are nil symptoms in the 5th finger.
Risk factors for carpal tunnel syndrome are obesity, repetitive wrist work, pregnancy, rheumatoid arthritic, genetics and the condition is more prevalent in women.
Treating carpal tunnel syndrome involves deloading aggravating activities. Anti-inflammatories may be prescribed through medications or with a cortisone injection. Physiotherapists may recommend a wrist splint to avoid excessive movements in the wrist and to be worn at night.
Once symptoms settle a progressive mobility and strength program is commenced to restore deficits.
In persistent cases, surgery may be needed to release the median nerve.
De Quervain's Tenosynovitis and Thumb Tendon Pain
The thumb tendon has a protective covering wrapped around the tendon called the tendon sheath. This helps the tendon with sliding and gliding so the highly mobile thumb can easily move. If the thumb is overused, the sheath may become inflamed and thickened. The tendon will lose its ability to glide smoothly which generates thumb and wrist burning pain (on the thumb side).
This painful thumb/wrist condition is De Quervain’s Tenosynovitis. Pain will come on gradually. The thumb side of the wrist may be mildly swollen.
Activities including gripping, rotating the wrist and general thumb and wrist movements may be painful.
Treatment of De Quervain’s is similar to Carpal Tunnel Syndrome listed above. Sufferers will need to reduce aggravating activities - usually gripping and wrist movements towards the 5th finger (ulnar deviation).
A custom made splint which covers the thumb and wrist may need to be made (store bought splints generally allow too much thumb movement). This stops excessive thumb and wrist movements that irritate the sheath. The splint may need to be worn at night to stop movements whilst sleeping.
Anti-inflamms may be recommended, initially as oral medications and then a cortisone injection if symptoms are bad.
If conservative management fails, surgery may be needed where the tendon sheath is opened and released.
Once symptoms are controlled, the wrist and thumb will undergo mobility and strength exercises to build up capacity.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!