Hand

CARPAL TUNNEL SYNDROME

The carpal tunnel is a narrow passageway on the palm side of the wrist. The floor of this tunnel is formed by the bones of the wrist and a strong ligament creates the roof. An important nerve called the median nerve runs through the carpal tunnel and gives feeling to the skin of the thumb, index finger, middle finger and half of the ring finger. This nerve also gives movement to some of the muscles around the thumb. Carpal tunnel syndrome occurs when there is pressure on the median nerve from a variety of causes.

What are the symptoms of carpal tunnel syndrome?

Numbness or pins and needles around the thumb, index and middle fingers are the most commonly reported symptoms of carpal tunnel syndrome. This may be associated with wrist discomfort. The pins and needles are especially noticeable at night as they can cause you to wake up.

Other common symptoms of carpal tunnel syndrome include:

  • wrist pain, particularly at night
  • weakness of the hand and thumb
  • difficulty grasping objects
  • pain radiating up into the arm.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel.

This can be caused by a narrowing of the tunnel, enlargement of the tunnel contents or general swelling in the area. This occurs fairly commonly as people age, during pregnancy and in conjunction with conditions such as:

  • wrist arthritis
  • wrist fracture
  • thickened tendons
  • tendon inflammation
  • hand trauma causing swelling.

How do I know if I have carpal tunnel?

If you have the signs and symptoms of carpal tunnel syndrome, you can have the diagnosis confirmed by a health professional.

A diagnosis of carpal tunnel syndrome can be made by your GP, physiotherapist or hand therapist. They will complete a clinical assessment and a couple of simple tests in the clinic. Occasionally, a nerve conduction study is required.

How can physiotherapy help with carpal tunnel?

Splinting

Splints that hold the wrist in a neutral position or a slight forward bend will aim to maximise the amount of room in the carpal tunnel and relieve pressure on the median nerve. Splints that hold the wrist in the extended (arched backwards) position can make the symptoms worse as the carpal tunnel space is reduced in this position. In more severe cases, a full resting wrist and finger splint may be required.

Ergonomic advice

Symptoms can be reduced by avoiding certain common wrist positions and activities that increase the pressure in the tunnel.

Tendon gliding exercises

These four gentle movements of your fingers give a gliding motion between the different tendons and the nerve to reduce swelling of the little adhesions that can form in the area due to swelling.

Swelling management

Compression gloves and other techniques to reduce swelling may be required, depending on the cause of your symptoms.

Nerve glides

Gentle movements of your arm and neck are thought to improve the movement of the median nerve and assist with the healing of the nerve after compression at the carpal tunnel. Gentle movement of the nerve may increase blood flow to the nerve, which helps the nerve heal and improve your symptoms.

Strengthening

You may need to strengthen your hand after you have recovered from the symptoms of carpal tunnel syndrome.

Surgery

Surgery is required for a small percentage of people with carpal tunnel syndrome. If there is loss of sensation or inability to contract the muscles supplied by the median nerve, then referral to a surgeon is necessary. A variety of other treatments, such as scar management, desensitising and special exercises, may be required after surgery.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

How effective is physiotherapy for carpal tunnel?

Physiotherapy gets the best results for carpal tunnel syndrome when treatment is started early (within the first three months) and when the symptoms are still mild.

Splinting for 3–6 weeks, even if it’s only at night, is strongly recommended.

In more severe and long-standing cases, with constant numbness or weakness in the small thumb muscles, surgical release will be required to improve symptoms.

It is important not to leave the condition untreated as permanent nerve and muscle damage can occur.

What can I do at home?

  • Try to avoid any positions or movements that make your symptoms worse, particularly repetitive tasks in poor wrist positions or static postures
  • Wearing a splint that holds the wrist in a neutral or slightly bent forward position at night is usually effective in reducing symptoms, and can also be worn during the day to help reduce your symptoms. Take care to avoid a splint that holds your wrist back, which is the case for most store bought splints, as this wrist position may increase your symptoms
  • Reduce hand swelling if it is a factor by keeping the hand elevated or by wearing a compression glove
  • Follow the exercise advice of your physiotherapist

How long until I feel better?

In mild cases, correct splint wear will usually have an immediate effect in reducing your symptoms, especially at night. If you do not get relief of your symptoms with physiotherapy, self-management and splinting as mentioned above, then your physiotherapist or GP will refer you on for a surgical opinion.

 

Source: Choose.physio

METACARPAL FRACTURE

A fracture is the same as a broken bone. The metacarpals are the bones that form the palmar section of the hand. A fracture to a metacarpal can occur at any part of the bone, but is most common at the ‘neck’, up near the knuckle. The most commonly fractured metacarpal is the fifth one, joining up to your little finger. This is called a ‘boxer’s fracture’ as it is commonly caused when punching an object.

What causes a metacarpal fracture?

As with any fracture, the severity will depend on the direction, location and amount of force that caused the bone to break. In some cases, the fracture will need to be ‘put back in place’ under anaesthetic to make sure the bone heals in the right position. Fractures that involve the joint, are in more than two pieces or are displaced (not sitting in the correct position) are more likely to need surgery.

Metacarpal fractures are mostly caused by hitting something hard with your hand while your fist is clenched.

The metacarpal is narrow at the neck, which is the most common place for it to break; however, it can occur anywhere along the bone depending on the direction and force of impact to the bone.

How do I know if I have a metacarpal fracture?

In most cases, you will have pain and swelling straight away at the fracture site.

You may still be able to move your fingers, although it will be sore to move and touch the area.

The finger may look different—the knuckle may ‘disappear’, the finger may point in a slightly different direction or look a little bit shorter—and there may be a lump in the palm of the hand or on the back of the hand. You can check the finger alignment by making a loose fist to make sure the fingers are not ‘scissoring’ or crossing over each other.

Some people experience very little pain. This is because the metacarpals have lots of supporting structures around them, like ligaments and muscles.

Diagnosis will be confirmed on X-ray by a GP or physiotherapist. Depending on how bad the fracture is, treatment may either involve a splint to hold the fracture in place or surgery to make sure your fracture heals in a good position.

How can physiotherapy help with metacarpal fractures?

The first thing that’s needed is an X-ray to work out which bone is broken and to what extent. This will guide what treatment is necessary. Your GP or physiotherapist will also look at your hand and do some gentle tests to work out if surgery is needed. If surgery is not needed, then your physiotherapist will make a custom splint, which will support the healing fracture.

Physiotherapy is extremely important following a metacarpal fracture. Under your physiotherapist’s instructions, you will start moving as soon as it is safe to ensure that you don’t get too stiff. Physiotherapists use a number of techniques to regain movement in your hand, wrist and fingers, including:

  • swelling management with massage and compression garments
  • soft tissue massage to help with muscle tension and pain
  • providing you with a home exercises program of specific movements and strengthening exercises.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

How effective is physiotherapy for a metacarpal fracture?

Metacarpal fractures are a very common hand injury. The chances of you having a speedy recovery with a good outcome are maximised by following your physiotherapist’s advice. You must have the hand resting in the right position for healing, for the right amount of time, regardless of whether you have had an operation or not.

It is important to commence moving as soon as it is safe to prevent stiffness in your hand. Your physiotherapist will guide you about when to start some gentle exercises, as well as when it is safe to remove your splint for certain exercises.

After surgery, to fix a metacarpal fracture, it’s important to get moving early, but safely, to ensure the tendons in your hand don’t get stuck in the healing scar tissue. Your physiotherapist will provide you with exercises to do depending on how the fracture has been fixed.

Later on, when the bone is strong enough, your physiotherapist can help with regaining the strength you require for all your normal daily activities.

What can I do at home?

In the early phases, ice and compression can be helpful in reducing swelling. It is also important to rest and elevate your hand as much as you can. Also, you need to make sure your shoulder, elbow and unaffected fingers don’t get too stiff, so move them gently and carefully a few times a day.

It is important to follow the advice given to you by your physiotherapist. During the time you are in a splint, you should minimise the use of your injured hand and wear the splint as instructed. It is also important to complete the exercises your physiotherapist gives you or you may end up with a very stiff hand.

 

How long until I feel better?

It may take several weeks for the healing fracture to become strong, but you may be able to do many day-to-day tasks prior to this. You may not be able to drive for the first few weeks, and some activities will be restricted. From about six weeks you will be able to gradually return to your activities, guided by your physiotherapist.

OSTEOARTHRITIS (OA)

Osteoarthritis (OA) refers to a painful joint condition that is the result of a number of movement, lifestyle and genetic factors that progress as you age. OA is the most common type of arthritis, affecting 56 per cent of Australian arthritis suffers. OA can develop at any age, although it is more common in people over 45 years old, and affects 48 per cent of people over 50. In the hand, the most common form of arthritis is at the base of the thumb, at the carpometacarpal joint. 

How do I know if I have osteoarthritis?

Arthritis affects each person differently and symptoms vary depending on what type of arthritis a person has and its level of severity.

The most common symptoms include:

  • joint pain
  • joint stiffness.

Other joint symptoms can include: 

  • redness
  • warmth
  • swelling
  • in the latter stages, catching, clunking or grinding in the joint
  • people may also feel generally fatigued or unwell because of their arthritis.

In the early stages, most people will notice joint stiffness or a mild ache, particularly in the morning. As symptoms worsen, swelling occurs with increased pain. In the late stage, joints can appear enlarged and slightly different in shape. In the fingers, bony bumps called Heberden’s nodes may develop. OA can be diagnosed by a medical professional such as a GP or physiotherapist. It involves physical examination and symptom reporting. Imaging, such as X-rays, can be helpful to check the joint space between the bones, which can indicate the amount of cartilage loss and help gauge the severity of the disease.

Other common types include knee osteoarthritis and hip osteoarthritis

 

How can physiotherapy help with osteoarthritis?

Your physiotherapist can offer practical advice on managing the symptoms of OA, ergonomic advice and strategies for everyday activities, as well as strengthening exercises to improve pain and function. Splints can be useful to restrict movement and provide support and positioning. Heat and massage can help reduce pain and soothe sore joints and tight muscles. Strengthening exercises are added when pain is more settled, but they often need to be performed gradually to avoid irritation. An important part of management of OA is changing the way one performs a certain activity. This will reduce stress on the joints that are already sore. Your physiotherapist will be able to provide advice on everyday strategies and recommend suitable assistive equipment.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

 

How effective is physiotherapy for osteoarthritis?

According to a recent report, there is encouraging support on conservative therapies for hand OA. A recent study showed that physiotherapy interventions were effective in reducing pain and improving function and quality of life for individuals with trapeziometacarpal (thumb) OA, and that a combination of interventions, rather than single interventions, were more effective. The low evidence on the effectiveness of hand exercises for OA is due to poor quality of the studies done.

 

What can I do at home?

Rest is the best treatment when a joint is painful and swollen. Apply ice on the area if it is particularly warm, swollen and sore. If the joint is achy but not warm or swollen, heat in the form of a water bath or wheat bag can be useful. Avoid activities that tend to increase your pain. When pain has improved, you can start some gentle exercises to improve your joint movement and reduce stiffness. For example, if you have OA in your finger joints, you can perform exercises for your fingers by fully straightening and then bending your fingers into a full fist, and then repeating.

Exercises should be performed in low repetitions. People can often hurt themselves more from overdoing these, thinking it will help them improve more. If you are unsure about what exercises are appropriate and how often to do them, speak to your physiotherapist.

 

How long until I feel better?

Treatment involves managing the condition. You should try to rest when you have pain. It can sometimes take several days to weeks to feel more comfortable. During the ‘painful’ period, take medications as prescribed by your GP and frequent rest breaks, avoid activities that increase your pain, plan your schedule ahead, and make use of your larger and unaffected joints to perform the task. If you are not getting better, see your GP and physiotherapist for further management. 

 

Source: Choose.physio

SKIER’S THUMB

Skier’s thumb is an injury to an important stabilising ligament (the ulnar collateral ligament) of the ‘knuckle joint’ of the thumb (where the thumb joins the hand). The ulnar collateral ligament is responsible for stability and strength of the thumb when pinching or gripping. With injury to this ligament, you may feel pain and swelling at the joint where the thumb joins the hand, weakness of pinch and grip and soreness to touch around the inside of the joint in the webbing.

How do I know if I have skier’s thumb?

Skier’s thumb can be quite painful, especially when you grip or pinch something with the affected thumb.

The thumb joint will usually be swollen and sore to touch.

Any kind of stretch to the injured area, for example if the thumb gets caught on clothing, can cause pain and weakness.

Your physiotherapist will test the stability of the ligaments and determine the grade of the injury. An X-ray is required to check if the ligament has chipped off a fragment of bone. A device that measures your pinch strength is a good indicator on the severity of your injury and this will be used to monitor healing over time.

 

How can physiotherapy help with skier’s thumb?

A partial tear of the ulnar collateral ligament needs to be supported to heal. Your physiotherapist will usually need to fit you with a splint, which stops further injury and pain, but allows gentle function. You can usually use your hand for day-to-day activities, as comfortable, in the splint. A significant skier’s thumb injury may require six weeks of full-time splinting.

While the injury is improving, it is usually possible to start some strengthening exercises. Once the ligament has healed, the protection of the splint is needed less, and you will be ready to start strengthening the thumb. You will need to tape or splint for sport for several weeks or for the rest of the season, depending on the grade of the injury. Often a special sports guard is required for return to contact sports for additional protection.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

 

How effective is physiotherapy for skier’s thumb?

In the case of partial tears, with good splinting and physiotherapy treatment, most people achieve full movement, strength and function.

Surgery is required for complete (grade three) tears with instability and also to fix a large fracture fragment. If surgery is required, physiotherapy is essential after the operation, to splint and support the repaired ligament, followed by gradual movement and strengthening.

 

What can I do at home?

First aid is rest, ice and compression for a soft tissue injury. If you think you may have a skier’s thumb, seek advice from a physiotherapist or GP as soon as possible. Avoid pinching and gripping with the thumb until it is protected in a splint.

The type and extent of the injury and the stability of the joint indicates what is safe to do. Suitable splinting, as guided by your physiotherapist, will ensure that you achieve good healing. At an appropriate time, regular exercises are essential to improve movement and strength.

 

How long until I feel better?

For partial tears, pain and function should improve as soon as the thumb is appropriately splinted. Mild sprains recover within days to weeks of treatment. More severe sprains and those requiring surgery take several weeks of constant splinting and may take a few months to achieve about 80–90 per cent strength. 

 

Source: Choose.physio