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Wrist & Hand

Wrist and Hand pain can have many causes, many of them subtle. Thorough assessment and diagnosis is key to effective treatment

There are multiple tendons that run over the wrist joint and a significant change in these tendons being used , for example with excessive smart phone use, gaming or breastfeeding, can lead to pain in these tendons.

 

Normally by the time that the person seeks help the condition is not inflammatory. This is why the correct terminology is not tendonitis (it is means inflammation) but tendinopathy. However, there may be inflammation of the tendon sheath (tenosynovitis) or other local structures. De Quervain’s is the name given when the extensor pollicis brevis and abductor pollicis longus tendons are involved which are the tendons that move the thumb. Physiotherapy treatment of this condition can be very effective and we see people who can barely lift a coffee cup or hold a pen returning to high level function. 

 

Carpal Tunnel is common condition of the wrist and hand that can cause tingling, pins and needles or numbness in the hand. The wrists and hands are innervated by nerves that come out of the neck. Therefore it is very common to have symptoms in the wrists or hands that stem from the neck, with or without the presence of neck pain. If you have pain in your hands or wrists it is really important that your Physiotherapist or Osteopaths assesses your neck to establish if this is a contributing factor or cause of your symptoms. If this is contributing to your symptoms then treatment will then be focused on this region of the body. We often see people who have been diagnosed with carpal tunnel syndrome or other wrist and hand conditions that are in fact caused by the neck. Subsequent treatment of the neck region therefore results in resolution of the distal symptoms.

 

It is important that treatment involves two main things:

  1. The temporary modification of the aggravating factor followed by an incremental return to these aggravating activities.
  2. A systematic programme of loading for the tendons starting with static resisted exercises and leading to dynamic exercises.

These need to be done through the full range that is required for day to day and sporting activities.

 

Temporary relief may be achieved by things like taping, splinting, acupuncture, massage and ultrasound. However these modalities will only provide short term relief and the progressive loading exercises are key to long term recovery. If there is no significant improvement in symptoms with correct assessment treatment, then an injection may be indicated.

 

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