Hand and Wrist Injuries: Causes, Symptoms, Treatment and Exercises
The hand and wrist provide us with the ability to grasp and preform fine movement patterns. The thumb joint is what classifies us as “homo”-sapiens and its evolution has helped humans to become the most successful species on the planet. Our hands are filled with a high-density sensory nerve fibers providing feedback to our brain. Because of the this the hands and fingers represent the largest area of brain real estate compared to all other body parts.
If you have experienced pain in your hands and wrist you know getting simple daily tasks complete can be challenging or impossible. There are many types of injuries that can happen, a traumatic injury like a wrist fracture or aches that develop into more sharp and debilitating pain for no apparent reason like a tendinopathy. In all cases, it is important that you have your pain assessed by a physiotherapist, chiropractor and or sports medicine doctor. The earlier you seek treatment from a professional the faster you will have pain relief and it is less likely stubborn compensations take over creating further problems.
What Makes the Hand and Wrist Unique?
The hand and wrist are made up of multiple joints that function independently but also need to work and coordinate together to achieve proper movement.
The wrist is divided up into different regions defined by the joint articulations:
- The Inferior Radial Ulnar Joint: This is the joint of the wrist where the two bones of the forearm come together. This joint is unique as between it lies the Triangular Fibrocartilage Complex (TFCC). The TFCC is an important complex structure made of soft tissue that includes a disk, meniscus and ligaments. It acts to protect, cushion and stabilize the wrist when weight bearing through the hands.
- The Radiocarpal/Ulnomeniscocarpal Joint: The carpals of the wrist are a series of eight small bones that make up the wrist. The eight bones are aligned in two rows one being closer to the wrist and the other row closer to the hand. The radial side of the wrist (thumb side) articulates with the bones called the scaphoid and lunate. The ulna side of the wrist (little finger side) does not articulate directly, it has the TFCC between the joint hence having meniscus in its name
- The Mid Carpal Region and Intercarpal Region: This is where the eight small bones of the wrist articulate with each other and then longer bones of the palm of our hand
- The Metacarpals and Phalanges: These are the long bones of the palm and finger bones. They have many tendons from the forearm attaching to them and also multiple pully systems for ensure ideal movement patterns.
It is safe the say the wrist and hand is a complex region with many anatomical articulations, ligaments, muscles, tendons, vasculature and sensory nerves all interacting to functionally provide us with the ability to grasp, feel and preform small motor movements such as writing.
What are the Causes of Hand and Wrist Pain?
In this condition your finger becomes stuck in a bent position with an inability to straighten, this is called a contracture. The cause of this condition is an abnormally tight band on connective tissue in the palm of the hand. The exact reason why this occurs is unclear. Please click here to learn more about Dupuytrens Contracture.
Carpal Tunnel Syndrome
This is a common condition found in office workers and manual laborers who use their hands repetitively and throughout the day. Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve that runs on the front aspect of the wrist into the hand and innervates the thumb and adjacent two and half fingers and nail beds. It also provides the motor input “wiring” to important muscles of the thumb. On its path through the wrist is travels through the “carpal tunnel” which is an anatomically small space and prone to compression due to the multiple tendons that run through it while having carpals and a thick band of connective tissue minimizing the space. Symptoms of CTS will appear as nerve pain in the hand, tingling, numbness, and weakness and will be more apparent at night. Please click here to learn more about Carpal Tunnel Syndrome.
De Quervians Tenosynovitis
This is the most common tendon issue in the wrist. It is created when there is irritation of the tendons coming from the forearm down to insert on your thumb. It is caused by overuse or forceful wrist and thumb movements. If you are suffering from this condition you will have pain located at the base of your thumb and wrist, pain with thumb/wrist movements and gripping. It can be common in office workers who type and mouse daily. Please click here to learn more about De Quervians Tenosynovitis.
The scaphoid is one of the eight carpal bones located in the row closest to the wrist on the thumb side. The bone can be damaged with a fall onto your hand. A fracture to this bone is more clinically significant as it is harder to catch on initial X-rays and it has a more vulnerable blood supply that can lead to complications with healing. It is important that this type of fracture is diagnosed and treated correctly and you are seeing a health care professional that can help determine this for you.
There are many different types of fractures that can occur at the wrist, the most common being a Collies fracture. This type of fracture is when the bone of your forearm, specifically the radius is disrupted just before it articulates with the carpals to become the wrist joint. This type of fracture can vary in severity and may need to be reset manually at a fracture clinic or with a surgical intervention. Typically, a patient is casted for six weeks to allow the bone to heal and following this will need manual therapy and rehabilitation to regain range and strength.
Triangular Fibrocartilage Complex (TFCC) Sprain
This is when the TFCC has been damaged, either by a tear or irritation of its structures. It can occur with repetitive heavy loading of the wrist when pushing off a surface or post wrist fracture. It will result with pain along the outside of the wrist, decreased in the range of motion, possible clicking with movement and pain specially when loading to push.
This is a sprain of tear to the ligament on the inside of the thumb joint. It is called Skier’s thumb as it can occur when you fall on an outstretched hand with a ski pole under your thumb creating the right leverage to sprain this ligament. It can vary in severity with the worst form also causing a small bony chip to break off at the ligament’s insertion to the bone. Most likely this will not occur and you will have a sprain that presents as pain, swelling and discomfort of the inside of your thumb. It may become stiff as it heals and then feel more unstable with wide thumb grip. It is important that you get proper treatment with a physiotherapist or chiropractor to ensure proper healing.
This is a small bump that feels firm or spongy and vary in size. It forms over joints or muscle tendons that are experiencing excessive friction from repetitive use or an underlying movement dysfunction. It is common in the hand and wrist but can occur in other areas of the body as well. It is a protective response from your body but over time can interfere with movement and become inflamed and painful. Please click here to learn more about Ganglion Cysts.
This condition presents when your finger catches or clicks when you open your hand. It also does not close easily and when forced to fully bend has difficulty straightening back out. It is caused when there is irritation of the anchor’s “pulleys” of the tendons of the fingers. This causes them to not glide well and results in thickening of tissue interfering with proper movement. Please click here to learn more about Trigger Finger.
Osteoarthritis (OA) of the Hands
The thumb and fingers are more susceptible to OA throughout a lifetime due the repetitive use of these joints throughout the day. Particularly, the thumb joint is common to have OA changes. OA of the hand can lead to deformity or increase size of the joints (knuckles) and can make daily tasks more painful or impossible to complete. Please click here to learn more about Osteoarthritis.
How can Physiotherapy, Chiropractic, Massage Therapy and a Sports Medicine doctor help your hand and wrist pain?
A team of healthcare professionals can personalize and direct your treatments to address your specific injury, your goals and help recover from faster. The hand and wrist are a complex area and here at Rebalance Sports Medicine we have a few therapists with special interest on their treatment and recovery. Treatments at Rebalance Sports Medicine with a Physiotherapist or Chiropractor can include controlling pain with therapeutic modalities, acupuncture or dry needling, improve range of motion of a joint with hands on manual therapy or manipulation, strength and motor control with exercises. The need for a brace or finger splinting can also be indicated and prescribed by our practitioners. Soft tissue release is also important and may require massage therapy treatment to reduce muscles tone and relax the nervous system. If your hand and or wrist injury is severe or appears to not be improving your physiotherapist or chiropractor will suggest you get assessed by our in-house Sports Medicine Doctors who can refer out for imaging if deemed necessary.
How Long Does it Take to Recover from Hand and Wrist Pain?
Depending on the cause, severity and what tissue is damaged recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program and follow their advice. Keep in mind that your physiotherapist and/or chiropractor treats these types of conditions regularly and will help you recover as quickly as possible.
What are the Best Exercises to Help with your Hand and Wrist Pain?
A well-rounded program should include range of motion, strengthening, and flexibility of the hand and wrist. These exercises should be individualized to your particular needs and goals. If you are returning to a particular activity the final exercise program will be catered to movements and forces required.
Some of the most commonly prescribed exercises are below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance.
For motor retraining please preform the exercises below slow and controlled paying close attention to good form, try as many reps until fatigue then repeat for 2 more sets.
- “Wrist Curls” Strengthening Exercises: To perform these two exercises take a light weight and do repetitive slow controlled curls in both directions (palm up and down). The amount of weight depends on what you can tolerate without pain, we suggest using a soup can or a slightly heavier 2-5 lb dumbbell.
- Lumbrical and Grip Strength: This can be done using a stress ball, putty or by just creating tension in your mid palm by opening and closing your hand like a talking puppet. Keep your fingers straight and hollow out the mid palm with your movement.
- Forearm and Finger/Hand Stretching: Perform these exercises with your wrist and hand in two positions. In both, straighten your elbow with your arm out in front. To stretch the back of your forearm, palm faces the ground, make a closed fist and bend your wrist downwards. For the front of the forearm, palm faces the ceiling, splay your hand open, straighten your fingers and bend your wrist and hand down to the ground. In both positions use your other hand to apply over pressure as tolerated. Make sure the stretch does not feel painful, just like a gentle pulling sensation. Hold 30 seconds and repeat 2-3x.
- Hand Tendon Gliding: Make a straight fist, table top fist, claw grip, straight fist and composite fist. Repeat 5 times per grip, every 2-3 hours.
How to Treat Hand and Wrist Pain at Home?
- If you have recent injury of your wrist and hand, you may first want to try a contrast bath. This will help to control the swelling and bruising. To prepare you will need two buckets, one with ice cold water and the other with warm. Place your hand in one bucket for 2 min then then other. Always end with cold. This will help you control swelling. If there is minimal swelling but the tissue is warm and painful ice might be the best choice. Apply ice with some compression to the tissue for up to 10min then remove for 10min and repeat up to 3x or as needed. This can be done every two hours or as needed.
- Protect your hand and wrist and avoid aggravation. There is tissue that has been damaged and you do not want to continue to add strain on this area, it needs the right amount of rest to be able to heal, especially early on. There are numerous bracing options that we sell in clinic that can help you protect and support the area as it heals. Also, our therapist with special interest in hand therapy can assist in making custom made splints. You will need to minimize aggravation by modifying any activity that makes you worse or interferes with healing. You will not need to apply the strategies indefinitely as the tissue heals introducing the appropriate stress gradually will be an important part of your healing process.
- Try the above-mentioned exercise program as tolerated.
- If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist or doctor to help direct you.
If you are experiencing hand and wrist pain an assessment and treatment for Physiotherapy, Chiropractic and/or Massage Therapist is highly encouraged. Contact us today!
Heather Imrie, FCAMPT Physiotherapist
Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.