Wrist & Hand Injury Treatments
WRIST IMPINGEMENT/ IMPACTION SYNDROMES
This is pain in the wrist due to the pinch-ing of structures within the wrist joint, usually during a traumatic end of range wrist movement (e.g. a fall onto an out-stretched hand), and typically with the wrist in extension (stretched back) and in combination with weight bearing forces
through the affected wrist (such as during gymnastics). Symptoms may in-crease upon firmly touching the affected region of the wrist, and on certain wrist movements (e.g. wrist extension). The painful wrist will be sore to the touch with restricted wrist joint mobility and often swelling.
Treatment can include: physiotherapy, home advice regarding supporting the bandage cooling, and RICE.
DE QUERVAIN’S TENOSYNOVITIS
Symptoms include pain and tenderness on the thumb side of the wrist, where the tendons pass through a narrow tunnel and attach to the base of the thumb. Crepitus or a creaking sensation may be felt when moving the wrist.
OVERSTRETCHED THUMB OR FINGERS
A thumb sprain occurs when the thumb is bent out of its normal range of movement, usually backwards. Damage occurs to the ligaments supporting the joint at the bottom of the thumb, and symptoms include pain in the web of the thumb when it is moved, and swelling over the metacarpophalangeal joint (at the base of the thumb). You may also have laxity and instability in the joint.
Treatment can include: RICE, strapping, thumb support, physiotherapy with gentle exercises, and laser.
Have you really overstretched your fingers and do they really throb?
This is the tearing of the connective tissue and/or the ligaments holding the bones of the finger together, typically after excessive stretching of the joint in one direction. It is associated with pain upon firmly touching the joint, restricted joint mobility, and often swelling.
Treatment can include: strapping, relative rest, and physiotherapy with home exercises.
Does your little finger tingle?
‘Handlebar palsy’ is the name given to a condition suffered by cyclists, and symptoms at rest and when moving the wrist can include: numbness, tingling, and weakness over the outside of the hand, little finger, and the outer half of the ring finger. In cyclists, this may mean checking the bike set-up, such as the height of the saddle and the handlebars, and the wrist position when riding. Correcting these problems will usually stop the symptoms.
Do your thumb and fingers get stiff after rest?
With osteoarthritis, your wrist, thumb, and fingers get stiff in the morning and after rest. The joints thicken, and cysts form on your finger joints due to calcific spurs – these are called Bouchard’s nodes. These unsightly lumps appear on your fingers. Treatment can include: physiotherapy, home exercises such as playing the piano, laser, deep oscillation, shockwave, and MRT.
Do you have a swollen wrist?
If so, this can be made worse by the bursa, a small sack of fluid that lubricates where tendons move in your joints. If the bursa is subjected to repeated trauma or friction then it can become inflamed and swollen, causing pain in the wrist.
This is when you injure your hand with a recoil – such as an old-fashioned car engine start – or fall, and it hurts in your palm. It can happen when hitting the ground during a golf swing, swinging a tennis racket or baseball bat, playing volleyball, or due to a fall onto an outstretched hand. The break is in one of the wrist bones located on the thumb side of the wrist called a scaphoid.
Swelling, tenderness on touching the thumb side of the wrist bone, and a markedly reduced wrist function are also present. Laser can help, as well as MRT to speed up the healing.
This is a break in one of the small wrist bones – the lunate – which is located in the middle of your wrist. Following a fall onto an outstretched hand, severe wrist pain from the time of the injury settles to an ache and can $radiate into the hand or forearm. There is swelling and tenderness upon firmly touching it and the severe ache is on the thumb side.
This break is in the radius bone near the wrist, and it is usually due to a fall onto an outstretched hand. Severe pain, that is usually located on the thumb side of the wrist,
may radiate into the thumb, hand, or forearm. As well as swelling, there is tenderness on palpating the affected region of the wrist, a markedly reduced wrist function, and sometimes, bone deformity. It will need a cast before any therapy can begin.
This is when you punch the wall in frustration, your hand swells up, and it’s difficult to move your fingers. It is likely that you have broken the knuckle, called the ‘metacarpal bones’ of the hand. This is usually due to a punch, hence why it’s called boxer’s fracture, but basically this is a direct blow to the back of your hand or a fall onto an outstretched hand. This can result in a
severe pain in the hand and can radiate into the wrist or fingers. It will swell and be sore to touch, giving you poor hand function, and sometimes a bony deformity.
Treatment can include: strapping, RICE, and gentle progression finger exercises once the bones have healed.
Your husband slams the end of your finger in a car door and you feel an intense pain – this could be a break in one of the small bones of the finger called the phalanges. This mostly occurs due to a traumatic direct blow to the finger such as during contact sports. This can result in severe pain in the affected finger, swelling, tenderness, a markedly reduced finger function, and sometimes bony deformity.
FLEXOR TENDON INJURY (JERSEY FINGER)
This is a tear in one of the flexor tendons in your finger. You will have pain in the finger-tip and an inability to bend the finger. Tenderness on the pad of the finger will be present, along with swelling and bruising, which will develop later.
Does your finger suddenly jam up for no reason?
This a form of tenosynovitis, meaning that your finger becomes bent in towards the palm of your hand. Tenosynovitis is an inflammatory condition of the sheath that surrounds a tendon. The inflamed and thickened tendon cannot slide through the tunnel, therefore, the finger gets stuck in a bent position and clicks or locks. If you have a repetitive job, rheumatoid arthritis, or diabetes, you are more at risk. MRI is needed for a clear diagnosis, and treatment may well include surgery, but if not severe, RICE, physiotherapy, laser, and splinting may help.
Does your thumb lock?
‘Trigger thumb’ is a form of tenosynovitis that occurs in the flexor tendon of the thumb – the thickening of the tendon causes it to get stuck and hold the thumb in a flexed position. Treatment is often surgery, however, RICE, physio exercises, laser, and splinting may ease mild cases.
ULNAR NERVE IRRITATION IN THE THUMB
Have you been rubbing your thumb and getting a tingling sensation?
‘Bowler’s thumb’ is an overuse injury resulting from compression or repeated friction on the inside of the thumb, causing pressure on the ulnar nerve. You get thumb pain with numb-ness, and tingling in the end of the thumb.
FINGER TENDON INJURY
If you catch your finger on a dry ski slope mat – like my father did – it can cause a tear-ing of the connective tissue surrounding one of the finger joints with separation of the bones, meaning that the joint surfaces are no longer next to each other, and the finger is deformed. This injury occurs as a result of a traumatic impact to the finger – most often with ball sports, horse riding, or skiing – and
causes severe pain in the finger. At the time you get a feeling of the finger ‘popping out’, leaving a deformity of the finger joint, and sometimes pins and needles or numbness remains due to tendon nerve irritation.
A boutonniere deformity – or ‘button hole’ deformity – is an injury to a tendon in one of the fingers, right down to the mid bone, resulting in a deformed shape. This usually occurs after an impact to a bent finger, forcefully bending it and rupturing the extensor tendon. Treatment may include: surgery or a splint, then intensive physiotherapy.
FINGER LIGAMENT INJURY
This is when you bend your finger back too far and it really hurts; the volar plate is a very thick ligament which joins two bones in the finger, and a volar plate injury occurs when the finger is bent back the wrong way too far, spraining or tearing the ligament. Treatment is initially RICE and strapping, then gentle stretches.
FASCIAL THICKENING IN PALM
‘Dupuytren’s contracture’ is a condition that affects the hand and fingers, causing the fingers to bend in towards the palm of the hand. Massage and stretching helps, but sadly surgery is often needed in order to regain finger range.
A wrist sprain is an injury to any of the ligaments that join bone to bone in the wrist. Sudden pain in the wrist (with swelling) will often occur after a traumatic impact or a twisting of the wrist, and sprains can vary from very mild to very bad. Repetitive sprains may develop into tendonitis or tendinopathy, inflammation, then the degeneration
of the tendons. Pain in the wrist continues with joint stiffness in the morning, local swelling, and tenderness over the tendon.
WRIST LIGAMENT DISRUPTION
This is the tearing of connective tissue and/or ligaments of the joint located between the ends of the forearm bones just before the wrist (distal radioulnar joint), typically as a result of a fall onto an outstretched hand, with twisting. The wrist is painful and swollen, and when touching the joint, wrist joint mobility is less (particularly with regards to the rotation of the wrist).
TFCC (triangular fibrocartilage complex) occurs when there is damage to cartilage tissue located on the little finger side of the wrist joint, usually due to excessive compression forces with twisting or side bending forces through the wrist – such as a fall onto an outstretched hand. Or it can occur during gymnastics, racket sports, or manual work, such as when using a hammer. Pain is located on the little finger side of the wrist and can radiate into the forearm or hand. There is tenderness on touching the wrist, as well as swelling, reduced grip strength, and often a clicking or catching sensation. It is not easy to diagnose, but a scan can help. Both a sports physiotherapist and consultant need to advise on your return to sport and treatment. Depending on the level of severity, it may need surgery.
FINGER TENDON RUPTURES
This is the complete tearing of one or more finger tendons, following a traumatic incident such as an impact to the finger during contact sports. Pain and swelling in the finger may radiate into the hand, there may be a significant weakness of the affected finger, and a deformity of the finger that cannot be straightened. Pain increases on touching the affected tendon, and treatment can include: splinting, laser, ultrasound, and gentle progressive rehab.
Are your fingers getting weaker, and do they tingle and bother you at night?
Carpal tunnel is a dull ache in the wrist and forearm that may radiate into the hand and fingers. The pain is worse at night, and weakness in the fingers and hand may occur, as well as a tingling or burning sensation.
This can be caused by trauma, aging, or repetitive stress, and diabetics are more at risk. Symptoms are caused by the compression of the median nerve in the wrist as it passes through a narrow channel in the wrist called the carpal tunnel, which also houses the flexor digitorum superficialis and flexor pollicis longus tendons of the forearm.
Treatment can include: Gunn IMS dry needling for the neck at C5/6, Acupuncture, physiotherapy postural exercises, RICE, and splinting. Initially, mobility and gentle stretching exercises should be done to restore the full pain free range of motion at the joint. Later, static (no movement) strengthening exercises can begin, and finally, normal strength can be restored through dynamic/moving exercises with resistance bands/ dumbbells. Investigations may also be performed to confirm the diagnosis including MRI scan, ultrasound imaging, electromyography, or a nerve conduction study.
This is tenderness on the thumb side of the wrist where the tendons pass through a narrow tunnel and attach to the base of the thumb. Crepitus – a creaking sensation – may be felt when moving the wrist. Finkelstein’s test is used to help diagnose De Quervain’s tenosynovitis: here, the thumb is placed in the palm of the hand and the wrist moved sideways towards the little pinky finger side to stretch the tendons. If pain is felt, the test is positive.
The tendons of the abductor pollicis brevis (thumb) and extensor pollicis longus muscles (also the thumb) pass through a tunnel or tube in the wrist and attach at the base of the thumb. This tube or sheath surrounding the tendons can become inflamed, preventing normal movement of the tendon and also creating pain. It is the inflammation of the sheath that surrounds the tendon as opposed to the actual tendon itself. Tennis, squash, or badminton – as well as canoeing, ten pin bowling, and golf – can cause this, and treatment can include: rest, ice, ultrasound, and a stretching and strengthening program. Rest is important to allow healing, and often, a wrist splint can ensure rest and help prevent any more painful movement.