WRIST HAND PAIN

SKIER’S THUMB (GAMEKEEPER’S THUMB)

Skier’s Thumb is caused by a traumatic force on the thumb that forces it out (radial deviation is the anatomical direction). It often occurs with skiing and football.

Signs and symptoms: Include pain in the knuckle of the thumb, swelling, and an unstable joint.

Diagnosis: X-rays often show a small fragment of the metacarpal that has been pulled off by the ligament (called an avulsion fracture).

Treatment: Usually consists of bracing or splinting of partial tears and in some cases, surgical repair if the tear is complete.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

POSSIBLE TREATMENT GOALS

• Decrease Risk of Reoccurrence

• Improve Function

• Optimize Joint Alignment

• Improve Muscle Strength and Power

• Improve Proprioception

• Self-care of Symptoms

• Improve Safety

• Improve Tolerance for Prolonged Activities

CARPAL TUNNEL SYNDROME 

Carpal tunnel syndrome is a compression of the median nerve within the carpal tunnel. There is pain, tingling, and in severe cases, numbness in the thumb, index middle and ½ of the ring finger.

It is typically caused by repetitive tasks involving the hand and wrist. Typing with the wrists resting on hard surfaces can result in this problem.

It is often worse at night or with driving and can lead to loss of grip strength and coordination. As the problem progresses, atrophy (muscle wasting) of the thumb muscles may occur.

Treatment: Typically consists of splinting the wrist in a neutral position (no bend in the wrist in either direction), anti-inflammatory medication, and most importantly, activity modification such as wearing a padded glove during cycling.

Surgical release of the transverse carpal ligament is often performed before muscle wasting occurs.

Physical therapy follows to help restore range of motion, strength, and to educate the patient of factors that can lead to a reoccurrence of the problem.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Isometrics 

• Mobilization 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Decrease Risk of Reoccurrence

• Improve Function

• Improve Muscle Strength and Power

• Decrease Nerve Compression

• Increase Oxygen to Tissues

• Improve Range of Motion

• Improve Relaxation

• Self-care of Symptoms

• Improve Safety

• Improve Tolerance for Prolonged Activities

GUYON’S CANAL SYNDROME (HANDLEBAR PALSY)

             Like Carpal Tunnel Syndrome, this condition is often seen in cyclists when the ulnar nerve is compressed in its canal over the wrist.

Cause: Resting the palms of the hands on bicycle handlebars is typically the cause.

Treatment: Is similar to that for Carpal Tunnel Syndrome - activity modification, such as wearing a padded glove during cycling, rest, splinting, and hand therapy - including ultrasound / Iontophoresis, exercise, and less often, surgery.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Isometrics 

• Iontophoresis

• Mobilization 

• Proprioceptive Neuromuscular Facilitation (PNF)   

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Decrease Risk of Reoccurrence

• Improve Muscle Strength and Power

• Decrease Nerve Compression

• Increase Oxygen to Tissues

• Improve Range of Motion

• Improve Relaxation

• Self-care of Symptoms

• Improve Tolerance for Prolonged Activities

DE QUERVAIN'S TENOSYNOVITIS

This is a common condition in which the tendons that extend or straighten the thumb and their surrounding sheaths (extensor pollisis brevis and abductor pollicus longus) become inflamed.

Pain is located at the base of the thumb and wrist.

De Quarvain's tenosynovitis is common with repetitive work activities such as wringing and scissoring tasks.

Treatment: Includes rest, splinting, and rehabilitation to restore flexibility, reduce inflammation and modify tasks and activities. Surgery is rarely indicated, but a steroid injection is occasionally necessary.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Isometrics 

• Mobilization 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

• Soft Tissue Mobilization 

• Stretching/Flexibility Exercise 

POSSIBLE TREATMENT GOALS

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Range of Motion

• Improve Relaxation

• Self-care of Symptoms

• Improve Safety

• Improve Tolerance for Prolonged Activities

FRACTURES OF THE FOREARM/WRIST

Fractures of the wrist and hands are commonly named for their anatomical location, how they occurred, or a doctor that discovered or studied the given type of fracture.

The fingers are susceptible to fracture in household mishaps, recreational injuries and work-related trauma.

Most hand fractures are stable and do not require surgery. However, occasionally, fractures will not heal without appropriate surgical intervention. Internal support or "hardware" is necessary to stabilize fractures.

The therapist may apply a form fitting, custom thermoplastic splint to protect the fracture during healing. These splints may be removed for exercise and hygiene.

Most therapy programs commence days to 3 or 4 weeks post op, to regain motion, decrease pain, and reduce swelling.

       Rehabilitation may continue for weeks or months to restore range of motion (ROM) and strength.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

POSSIBLE TREATMENT GOALS

• Improve Function

• Improve Muscle Strength and Power

• Decrease Postoperative Complications

• Improve Range of Motion

• Self-care of Symptoms

• Improve Wound Healing

DISTAL RADIUS FRACTURE COLLES, SMITH FRACTURES

These fractures often result from a fall onto an outstretched hand or because of a direct blow.

Symptoms: Pain, tenderness, and deformity are common.

Diagnosis: X-rays are used to rule in/out a fracture.

Treatment: For a fracture involves “closed reduction” in which the bones are moved back into alignment.

If the bones cannot be moved back into the proper position manually, open reduction and often internal fixation is used. This means that the bones are surgically positioned next to each other and might be pinned, screwed or wired together.

Early intervention / rehabilitation - Is helpful to reduce pain, increase range of motion, and ultimately restore strength and function.

        Wrist supports and custom splints are helpful to protect the area so optimal healing can occur.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

• Soft Tissue Mobilization 

POSSIBLE TREATMENT GOALS

• Improve Function

• Improve Muscle Strength and Power

• Increase Oxygen to Tissues

• Improve Range of Motion

• Self-care of Symptoms

SCAPHOID FRACTURE

This is a common carpal wrist bone fracture. Often wrongly diagnosed as a wrist sprain.

Symptoms: There is tenderness or pain where the base of the thumb meets the wrist, an area called the anatomical snuffbox.

Occurs: It usually occurs in the adolescent or young adult with a fall on the outstretched hand or with high velocity wrist injuries (like motorcycle accidents).

Treatment: For a scaphoid fracture can be difficult. If there is just a crack in the scaphoid bone, it requires a thumb splint for 6 weeks or until healed. If the bone is completely broken apart, it will require surgical fixation. Because of the unusual blood supply, the fracture may not heal completely (delayed union) or Avascular necrosis (death of the bone because of loss of the blood supply) may result.

POSSIBLE TREATMENTS

• Active Range of Motion (AROM)   

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Electrotherapeutic Modalities

• Isometrics 

• Progressive Resistive Exercises (PRE)   

• Passive Range of Motion (PROM)   

• Physical Agents

POSSIBLE TREATMENT GOALS

• Improve Function

• Improve Muscle Strength and Power

• Improve Range of Motion

• Self-care of Symptoms

MALLET (BASEBALL) FINGER

This fracture results from a trauma to tip of the finger forcing it into flexion (rapidly bending it down toward the palm) and avulsing the extensor tendon. This injury commonly occurs in baseball and basketball when attempting to catch a ball.

Signs and symptoms: Include pain, swelling, and an inability to straighten out the last digit of the involved finger.

Treatment: Includes splinting of the finger in the straight position for 6-8 weeks. In some cases, surgical pinning of the finger in a straight position along with splinting is necessary.

POSSIBLE TREATMENTS

• Active Assistive Range of Motion (AAROM)   

• Cryotherapy or Cold Therapy 

• Isometrics 

• Physical Agents

POSSIBLE TREATMENT GOALS

• Improve Function

• Improve Muscle Strength and Power

• Self-care of Symptoms