fbpx

Wrist

DEQUERVAIN’S TENOSYNOVITIS

 

DeQuervain’s is pain on the thumb side of the wrist, about where a watch would rest. It is associated with movement of the wrist or thumb. You will normally notice the pain when you lift up a baby, reach out to grab something with an open thumb or lift the thumb up and down repeatedly. You can also notice pain in positions where your wrist is bent forward and towards the little finger side of your hand. Side-to-side movement of the wrist is another common movement that will cause symptoms. The pain will be even worse if you are holding something heavy or doing something requiring force.

What causes DeQuervain’s?

DeQuervain’s is very common in new parents. This is due to holding and lifting a new baby with the thumbs up, combined with an up-and-down movement at the wrist and holding their baby on their hip for sustained periods. DeQuervain’s is also common in work that requires strong or repetitive thumb and wrist movements. Direct trauma such as falling on your wrist or thumb, a sudden twisting force in the area or a direct blow to the side of the wrist can also cause DeQuervain’s.

You can easily see the tendons affected by DeQuervain’s when you do a thumbs-up sign with your hand. These tendons help to lift the thumb up and out. They’re held down onto the bone at the level of the wrist by a strong pulley, or sheath. The pain of DeQuervain’s is due to a thickening of the sheath, which causes a tightening over or compression of the tendons, and sometimes swelling in the area. This makes movement of the tendon painful.

 

How do I know if I have DeQuervain’s?

DeQuervain’s will often become apparent due to pain and swelling over the thumb side of the wrist. The pain will sometimes travel down into the thumb or up into the forearm.

If lifting your thumb is difficult or painful, or if bending it down towards your little finger hurts, you could have DeQuervain’s. Other conditions that occur around this area may have similar symptoms, but different causes and treatment. Your physiotherapist or hand therapist will help you to diagnose this.

If the swelling is large enough, you might feel sensations of clicking, flicking, catching or locking in your wrist. Sometimes these are pain-free and are the only sign of DeQuervain’s that you’ve noticed.

 

How can physiotherapy help with DeQuervain’s?

Splinting 

Your physiotherapist or hand therapist will make you a splint to greatly reduce the movement of the thumb tendons. This splint will need to hold the wrist and part of the thumb still, but you will still be able to do everything you need to do with the splint on. The splint will be required for up to six weeks.

Education on activity modification 

Simple adjustments to your activities can be very helpful, like changing the wrist and thumb position you use when you’re lifting things or avoiding static holding positions of the thumb and wrist that are painful. There are many things a physiotherapist can show you that will reduce the pain.

Exercises

Rehabilitation exercises of the thumb tendons will help reduce the pain and also strengthen the area. Regular exercises are known to be a vital part of treatment and are important to help prevent a recurrence of the condition. Generalised strengthening of the shoulders and elbows can also place less load at your wrist, helping long-term recovery.

Massage and other soft tissue techniques 

Soft tissue techniques to relax the muscles may be incorporated into treatment sessions with your physiotherapist to help reduce the tension in the muscle/tendon unit. This can help the other treatments outlined here.

 

How effective is physiotherapy for DeQuervains?

People with DeQuervain’s can expect a full recovery most of the time, especially with splinting and activity modification. The treatments listed above may need to be combined with a cortisone injection from a doctor or specialist for full recovery. In a small number of cases, splinting and cortisone will not be enough to fully resolve the symptoms and surgery may be needed to release the tendon sheath.

 

What can I do at home?

  • Wear your splint as much as possible, even in bed at night. Be sure to continue to use your hand in the splint for any activities that don’t hurt. But, it’s important that you avoid painful activities for the period of time your physiotherapist has advised.
  • Follow your physiotherapist’s advice on avoiding the positions and movements that are aggravating the condition. When you are lifting your baby, you can try to keep the wrist in a straight position with the thumbs by the side of your hand, lifting them up in a scooping type of motion.
  • Avoid pressing with your thumb as much as possible, try using pull on baby pants instead of grow suits with press studs.
  • You will also have specific exercises to complete at home when appropriate. It is important that you do these as guided by your physiotherapist to make sure you regain full movement and strength.
 

How long until I feel better?

You will be able to do a lot more with reduced pain as soon as you are fitted with the right splint.

Your recovery time will depend on the severity of your DeQuervain’s and how long you have had it before seeking treatment. Splints will be needed for 2–6 weeks, followed by a period of rehabilitation to regain full movement and strength of the tendons.

Source: Choose.physio

GANGLION CYST

A ganglion is a lump on the back of your wrist. Ganglions are cysts (collections of fluid) that vary in size and firmness. They may be soft and squishy, but sometimes feel hard like a bone. Very small ganglions that are difficult to see can be the most painful because of the level of fluid pressure inside the cyst. Some ganglions, even very large ones, can be completely pain-free.

 

Tell me more about ganglion

Ganglions involve the joint fluid in the wrist bulging (outpouching) from inside the wrist, or sometimes from the sheath around a tendon. They are completely safe and harmless, though the pain can be distressing and may limit your activity.

The ganglion will be more obvious when you bend your wrist forward, and it may be difficult to fully lean on your wrist (doing a push-up, for example), because the ganglion gets squashed in this position.

Ganglions tend to come and go according to how much activity is undertaken, although they can be quite unpredictable.

 

What causes ganglions?

There are a few different theories about what causes ganglions to form. A ganglion may develop after an injury or trauma to a joint or ligament in your hand. It may also form due to repetitive use of your hand, fingers or wrists. Finally, ganglions may also form due to a bulging out (herniation) of the joint capsules that surround each of the joints in your hand.

People in certain occupations—for example, guitarists, violinists and hairdressers—have a greater chance of forming a ganglion due to sustained forward wrist positions.

Many ganglions are described as ‘idiopathic’, which means that no obvious cause can be identified.

 

How do I know if I have a ganglion?

Ganglions may appear suddenly or they may develop gradually over time. They usually look like a lump on the back of your wrist. Ganglions tend to fluctuate up and down in size over time, and may also change depending on your activity.

The lump will become more prominent when your wrist is flexed forward.

You can confirm the diagnosis of a wrist ganglion by getting an ultrasound, although this is rarely necessary. A doctor, physiotherapist or hand therapist will normally be able to give you a diagnosis after an examination in the clinic.

 

How can physiotherapy help with ganglions?

In many cases ganglions do not require any treatment, and approximately half will resolve over time without intervention. If a ganglion is not causing pain or limiting the use of your hand, then no treatment is required. However, if a ganglion is causing pain, limiting the use of your wrist or hand, or causing compression of a nearby nerve (which may cause altered sensation, numbness or pins and needles), treatment is recommended.

The treatment that’s needed could be:

Splinting

A wrist splint may help to reduce the pain of a ganglion.

Strapping techniques

Properly applied strapping tape can often enable you to continue a higher level of loading activity (at the gym, for example) without provoking the ganglion. Your physiotherapist can show you how to strap your wrist correctly.

Activity modification 

You can reduce the symptoms of a ganglion by modifying your activities and understanding what wrist positions to avoid.

Exercise

A gentle home exercise program to maintain the range of movement and function in your hand is recommended. A carefully graduated exercise program can, in some cases, desensitise the ganglion and enable the wrist to return to more normal, pain-free activity levels.

In a small percentage of people with wrist ganglions, steroid injection, aspiration (needle drainage) or surgery is required. Following the surgical removal of a ganglion, you will need physiotherapy or hand therapy for splinting, tendon gliding and careful advice about returning to normal activities.

 

How effective is physiotherapy for ganglions?

Physiotherapy treatment is useful to reduce pain, improve function and educate patients about their wrist ganglion.

Patients with ongoing pain or limited function may choose to have an injection or aspiration (drainage) of their ganglion, or even opt for surgery. Studies have shown a 60 per cent recurrence rate following aspiration of ganglions. Surgical removal of ganglions is considered the most effective treatment if non-surgical treatment has failed, though there is also a risk of recurrence with surgery (approximately 16 per cent). 

Physiotherapy treatment is important following surgery in order to minimise the risk of post-operative complications such as recurrence, stiffness and scarring.

 

What can I do at home?

The most important thing you can do at home is simply avoid the movements or activities that aggravate your pain or discomfort. Remind and reassure yourself that your wrist is safe, and that the pain does not indicate anything dangerous or sinister in your wrist.

Movements to avoid include leaning on your wrist, bearing weight through your wrist (eg, pushing up from a chair), bending your wrist all the way forward (flexion) and holding your wrist in the forward position for longer periods of time.

You can wear a wrist splint to relieve some of the pain associated with your ganglion.

 

How long until I feel better?

Ganglions come and go, so your symptoms may be short-lived and then occasionally reappear. Approximately half of all wrist ganglions will get better without treatment within a couple of years. For painful ganglions, a supportive splint will give immediate relief.

Following surgical removal of a ganglion, physiotherapy or hand therapy will normally be needed for 6–8 weeks to ensure you regain your full range of movement, strength and functional use of your hand, as well as to prevent the ganglion from recurring.

Source: Choose.physio

SCAPHOID FRACTURE

A scaphoid fracture is a break to the scaphoid bone, which is one of the eight carpal bones in the wrist. The scaphoid is the most commonly broken carpal bone, responsible for 80–90 per cent of all carpal fractures. The scaphoid bone is the cornerstone of the wrist, and it is extremely important that a fracture is allowed to heal properly with the right treatment for the right amount of time.

What are the symptoms of a scaphoid fracture?

Scaphoid fractures are easy to miss at the time of injury because the fracture doesn’t always show up on the first X-ray.

The symptoms of a scaphoid fracture are:

  • wrist pain on the thumb side
  • pain when you pinch your thumb to your index finger with the palm facing downwards
  • swelling around the painful area (including loss of the ‘snuff box’ (triangular deepening) divot normally seen when you lift up your thumb)
  • weak wrist and reduced grip and pinch strength
  • reduced and painful movement of the wrist.
 

What causes scaphoid fractures?

Scaphoid fractures are usually the result of a fall on an outstretched hand, particularly if you land on the base of the thumb. Often the wrist is forced too far backwards, although a forceful bend forward can also fracture the scaphoid. Sometimes, the fall involves speed or height.

Scaphoid fractures are divided into three categories and each requires different treatment to make sure the bone heals completely.

Each part of the bone has a different amount of blood supply, which can influence how the fracture heals. A proximal pole fracture has poor blood supply, making the healing process more difficult. This increases the chance of the fracture not healing.

The right treatment for a scaphoid fracture varies from a cast (worn for 6–12 weeks) to the surgical fixation of the bone plus a cast.

 

How do I know if I have a scaphoid fracture?

If you have the symptoms described above after sustaining a fall, it’s important to see your GP or physiotherapist for an X-ray. You may need a follow-up X-ray because these fractures sometimes do not show up on initial X-rays. After 10 days, the fracture is more likely to show up. Your GP or physiotherapist may also suggest an MRI. This is more expensive, but shows the scaphoid bone much more clearly.

After the initial injury and after the swelling settles down, you tend to feel the symptoms of a scaphoid fracture around the bone. You can suspect you have a scaphoid fracture if you have ongoing pain around the area where your thumb meets your wrist after a heavy fall, even if the X-ray at the time was clear. A 50 per cent decrease in grip strength compared to your other wrist also suggests a fracture.

 

How can physiotherapy help with scaphoid fractures?

Cast or splint

You will have a plaster cast or thermoplastic splint fitted. The elbow is usually left free, and the thumb is often included, although there is increasing evidence that it is safe to leave the thumb out of the cast. Sometimes a temporary plaster ‘backslab’ will be applied for the first week, to be replaced with a waterproof cast once the initial swelling has settled down.

Rehabilitation

Your physiotherapist or hand therapist will be involved in rehabilitation after your cast is removed or after you have an operation to fix the bone (whichever is required in your case).

Exercise

You will be given a set of graduated exercises designed to regain your full movement and wrist strength.

Mobilisation and soft tissue techniques

You may have reduced movement in your wrist and thumb, requiring correction through mobilisation and soft tissue techniques.

Return-to-sport and work

The timing of your return to sport or work will depend upon your progress and the physical demands that will be placed upon your wrist.

 

How effective is physiotherapy for scaphoid fractures?

People with scaphoid fractures usually require the help of a physiotherapist to overcome the stiffness that develops in their thumb and wrist joints, and the weakness in their hand that comes from a period of immobilisation in the cast or splint. Your physiotherapist can guide you on appropriate exercises to get your joints moving and improve your strength over time, so you can gradually return to your usual activities.

There is currently a lack of studies on the effectiveness of physiotherapy or hand therapy specifically for scaphoid fractures. However, rehabilitation is widely recognised as an important part of each person’s recovery from a scaphoid fracture.

 

What can I do at home?

  • Keeping your arm elevated in the early days after a fracture is helpful to reduce swelling
  • It is also important to make sure your shoulder, elbow and fingers don’t get stiff, so keep them moving when the cast is on. You should have full finger movement in your cast and be able to make a full fist as well as being able to move at least the tip of your thumb
  • You will be given a home exercise program to complete by your physiotherapist
  • It is usually safe to use the injured hand for light activities, with the splint or cast on and within the limits of pain. Talk to your GP or physiotherapist about which activities are safe for you to do.
 

How long until I feel better?

Scaphoid fractures take 6–12 weeks to heal. It is fairly common for people to still experience some stiffness or mild discomfort up to 12 months after their fracture. 

Source: Choose.physio

WRIST FRACTURE

A fractured wrist is the same thing as a broken wrist. A wrist fracture usually occurs from a fall on an outstretched hand or from a very heavy direct blow to your arm. There are two bones in your forearm: the radius and the ulna. The most commonly fractured bone is your radius. The radius is the bone that takes 80 per cent of your weight when you push up from your hand. 

What causes wrist fractures?

Fractures in the wrist are usually caused from a fall on an outstretched hand. The bigger the force when you fall (eg, from a height or with speed), the worse the fracture. A fractured wrist will be treated with either a cast or an operation. The right treatment for you will depend mostly on the severity and the position of the break. Most people think that a fractured wrist will be fine after the cast comes off and they are surprised if the wrist is still stiff, sore or swollen. It’s actually quite normal to need physiotherapy to get the wrist moving normally again after a cast or operation.

Reduced movement in your wrist after the cast is removed can be due to the fracture position. If the fracture went through the wrist joint, or involved the joint between the two forearm bones, there is likely to be some restriction to your movement in the early phases of rehabilitation.

Pain and swelling after the cast is removed may be because soft tissues (such as ligaments) were injured at the same time as the wrist fracture.

Ongoing symptoms can be related to the final fracture position and a host of other reasons. It’s not always possible to get the wrist to heal back into a perfect position, for example.

Whatever the reason for ongoing symptoms, your physiotherapist will have a lot of treatment options to help you.

 

How do I know if I have a wrist fracture?

It’s usually very painful and clear when an adult has fractured their wrist. That being said, occasionally small cracks may be missed and if you have ongoing pain after a fall, you are advised to get an X-ray.

However, children often have small fractures that are missed or put down to a sprain. It’s always advisable to see your GP or physiotherapist about a child’s painful wrist after a fall or a heavy blow (eg, from a hockey stick).

Signs of a fractured wrist include reduced movement, pain and swelling. Diagnosis is made after reviewing X-rays.

 

How can physiotherapy help with wrist fracture?

Physiotherapists and hand therapists are often involved in fitting fractured wrists with protective splints to immobilise them (keep them still) as they heal, especially in children and for simple, undisplaced fractures. Undisplaced fractures are where the bone only breaks in one spot and the two pieces of the bone remain aligned.

Physiotherapy is often required in the rehabilitation stage once the fracture is healed and will include:

  • Exercise: You will be given a graduated exercise program to regain the movement, strength and stability (proprioception) of the wrist. 
  • Mobilisation and soft tissue techniques: Hands-on techniques such as joint mobilisation and massage will help you to regain movement in the joint, and will also reduce any discomfort in the wrist and arm.
  • Swelling management: You may require some form of compression if you have ongoing swelling. This may be a compression sleeve or a glove in addition to elevation.
  • Return-to-work and sport: The timing of your return to work and sport will depend upon your injury, your recovery and the demands placed on your wrist from particular activities.
  • Brace: A brace may help you return safely to sport or work earlier.
 

How effective is physiotherapy for wrist fractures?

Physiotherapy that’s started early after a wrist fracture has been shown to improve outcomes associated with pain, strength and movement. It has also been shown to lead to an earlier return to function.

 

What can I do at home?

Keeping your arm elevated in the early days after a fracture helps to reduce swelling. It is also important to make sure your shoulder, elbow and fingers don’t get stiff, so move them gently and carefully a few times a day.

If your wrist remains very painful or is getting more painful, get back in touch with the person or place that put your cast on. If you are unable to make a full fist, you should also check in with them. Sometimes the first plaster can be too long or too tight and cause finger stiffness.

You will be given a home exercise program to complete by your physiotherapist or GP. It’s very important to follow their recommendations to ensure you get the best possible outcome. Most people underestimate the impact of a wrist fracture, so it’s best to listen to the advice you’re given.

 

How long until I feel better?

As a general rule it takes 12 weeks for your fracture to heal, but it’s fairly common for people to still experience some stiffness or mild discomfort for 12 months (or even longer) after they’ve fractured their wrist.

Source: Choose.physio

SPRAINS AND STRAINS 

A wrist sprain is an umbrella term used to describe an injury to the soft tissues of the wrist. Soft tissues include muscles, the joint capsule, ligaments and tendons. A wrist sprain can be a minor injury or it can be a very serious injury, depending upon which tissue has been injured, and how badly. ‘Wrist sprain’ doesn’t specify which exact tissue is injured, or how badly it is injured. The term is used to indicate that no bones appear to be broken, but this can trick people into thinking that it’s not a serious injury, which can be misleading. 

Tell me more about wrist sprains.

The right treatment for a soft tissue injury of the wrist is based upon a good clinical assessment of which tissue is injured, and how badly it is injured.

A lot of wrist sprains heal reasonably quickly with a short period of rest, and there are no lasting side effects. However, a small number of these soft tissue injuries cause significant pain and dysfunction because important structural ligaments have been damaged. The most severe wrist sprains involve damage to the ligaments that hold the 10 bones of the wrist together. These sprains can affect the long-term stability of the entire wrist and lead to ongoing pain and weakness. You might also find your wrist starts to ‘give way’ when you use it to lift something or take your body weight.

Ligament injuries are classified into grades according to severity. Ligament tears can be painful at any grade, especially when they first happen.

Grade 1: The ligaments are stretched, not torn. These usually take 2–3 days to heal.

Grade 2: Moderate sprains with partial tears of the ligament fibres. The ligament is partly intact and can take 2–6 weeks to heal.

Grade 3: The ligament is completely torn. These can take 6 weeks to heal. In some cases, they require surgery.

 

What causes a wrist sprain?

Wrist sprains happen when the wrist is forced too far in one direction and tissues are stretched or torn. A common cause is a fall onto your outstretched hand, especially from a height or at speed. Young people’s bones are very strong, so they can fall quite heavily and not break a bone. Instead, they might sprain their wrist. The same fall in an older person might result in a fractured wrist.

Soft tissue injuries are very common in ball sports or from falling off a bike. They may also happen when the wrist or hand is over-twisted, like when you use a drill or racquet that forces your forearm into excessive rotation. The force and direction of the injury will affect which soft tissues in the wrist are damaged and how badly.

Another cause of soft tissue injury is called attrition. You can gradually wear down a ligament until it breaks by putting strain through it repeatedly over many years. A good example of this is repeated forceful squeezing of electrical pliers straining the scapholunate ligament in the wrist. You can be doing the exact same thing as always and simply hear a pop, or feel something ‘go’.

 

How do I know if I have sprained my wrist?

It’s important to pay attention if your wrist sprain doesn’t go away completely after a few days. A wrist sprain can be something very simple or a more serious soft tissue injury, requiring the right treatment in order to heal. It’s recommended that you have your wrist injury properly assessed if it’s still sore after a few days. It’s strongly advised that you get a good clinical assessment by your physiotherapist or a hand therapist to get a diagnosis on the injured structure.

Immediately after the injury, the wrist will be painful and swollen. Usually movement will be difficult and it may not be possible to lift anything heavy or lean on it. X-rays will show that no bones are broken, but this does not tell you how serious the sprain is.

As time goes on, you may notice pain when lifting or pushing up from a chair, or you might not be able to complete all your usual activities without pain. In the situation where after a week, your wrist feels better but not 100 per cent, it’s advisable to see your physiotherapist or a hand therapist for a diagnosis. It’s a lot easier to fix the problem in the initial stages compared to six weeks (or months!) later.

 

How can physiotherapy help with a wrist sprain?

Diagnosis

The most helpful thing your physiotherapist can do is make a diagnosis of your wrist sprain and tell you which tissues appear to be injured, and how badly. The right treatment will depend upon this diagnosis.

Treatment

Initial treatment of sprains involves rest, often by placing the wrist in a splint or brace or by taping it. Physiotherapists who specialise in upper limb injuries can make a splint that is best suited for your injury, taking into account the structures that are damaged and need protecting. This may need to be worn full-time initially, followed by a period of part-time use as you get back to your normal pre-injury activities.

Swelling can be reduced by rest, compression, elevation and ice. Your physiotherapist might also perform soft tissue treatments on the surrounding muscles and tendons, which can become tight and painful during the healing phase. To do this, they may use heat, massage or dry needling.

Exercises

Exercises are needed to regain movement, strength and stability (proprioception) of your wrist. The exercises you do will depend on which ligament is damaged, as some muscles help certain ligaments while others put more strain on the ligament. These exercises need to be introduced carefully and gradually by your physiotherapist.

 

How effective is physiotherapy for a wrist sprain?

Physiotherapy (or hand therapy) is the right treatment for most moderate to severe soft tissue injuries. If your wrist is unstable due to the complete rupture of one or more ligaments, you may need surgery to repair the injured ligament/s. After surgery, it is very important that your physiotherapist guides you through the rehabilitation phases in conjunction with your surgeon. This will ensure a complete recovery without damaging the repair.

 

What can I do at home?

  • Elevate the hand to limit swelling
  • First aid for any soft tissue injury (including a wrist sprain) is ice, compression and rest
  • Use a crepe bandage (available from most pharmacies) or a wrist splint to protect the wrist until it settles down
  • Avoid carrying heavy objects or gripping anything too tightly until your symptoms disappear
 

How long until I feel better?

Wrist sprains can take anywhere from three days to six months to get better. Unfortunately, without correct treatment wrist sprains can also become a chronic injury, causing pain and disability in years to come.

If your wrist is still sore a few days or a week after your injury, it’s a sign you may need a proper diagnosis and professional help from your physiotherapist or hand therapist.

In most cases, once your wrist is immobilised in an appropriate splint, the pain will immediately reduce. This ensures the damaged ligaments are fully supported and accidental movements don’t stretch the healing ligaments. Within the splint or brace, you can usually complete gentle tasks, but must avoid tight gripping as this puts pressure on the ligaments.

Source: Choose.physio