Physical Therapy for Wrist and Hand Injuries
Wrist and hand injuries are common as the complex structure of the wrist and hand are susceptible to irritation from overuse at work or sport or from excessive force placed on the wrist or hand when breaking a fall. Wrist and hand injuries treated by physical therapy include wrist tendinitis, carpal tunnel syndrome, arthritis, trigger finger, and sprains and strains. Physical therapy is an effective treatment for wrist and hand injuries, helping control swelling and restoring range of motion, strength, and ability in the wrist and hand through manual therapy, therapeutic exercise, and functional training.
Anatomy of Wrist and Hand
The wrist is a complex joint that connects the hand to the arm and allows the hand a great deal of mobility to perform daily activities at home, work, and sport. The wrist is made up of 15 bones that are held together by a complex network of ligaments. The wrist has 24 tendons that connect the muscle to bone. The tendons attach at the wrist and travel through the hand to the fingers and thumb. Three nerves travel through the wrist toward the fingertips.
The hand is comprised of three major types of bone (phalanges, metacarpal, and carpal bones) and numerous muscles, ligaments, tendons, and sheaths. The phalanges are found in the fingers of each hand, while the metacarpal bones are located in the middle part of the hand and the carpal bones create the wrist. The muscles of the hand allow for movement of the bones of the hand, while the ligaments help bind together the joints in the hand. The tendons connect muscles in the arm and hand to the bone to allow movement, while the tendon sheaths, thin layers of connective tissue, surround, protect, and lubricate the tendons.
Common Wrist and Hand Injuries
Injury to the wrist and hand are common as we often put our hand and wrist out to break a fall and utilize these complex structures continually in work and sport. The wrist and hand are susceptible to irritation and inflammation from overuse or due to medical conditions like arthritis.
Common wrist and hand injuries include:
Wrist tendinitis: occurs in those who perform repetitive activities of the hand and arm, such as excessive computer users, factory workers, and baseball and tennis players. It is a condition in which 1 or more tendons in the wrist become irritated and inflamed. If tendinitis persists over time untreated, it can become chronic tendinopathy.
Symptoms of wrist tendinitis include pain where the arm meets the hand, radiating up the elbow; pain on the thumb side or little finger side of the wrist; pain that occurs when the wrist is under strain or when putting pressure on the hand; stiffness and swelling in the wrist; tenderness in wrist and forearm muscles; and decreased ability to bend and extend the wrist.
Carpal tunnel syndrome (CTS): occurs due to a pinched nerve in the wrist, which can cause pain, weakness, tingling, and numbness in the wrist, hand, and fingers. It is common in those who use machinery that vibrates, excessive keyboard use, and activities requiring repetitive hand and wrist use like racquetball or sewing.
Arthritis: is a common cause of pain in the hand, leading to weakened grip strength, swelling and inflammation of the joints of the hand and wrist, and loss of range of motion.
Osteoarthritis: joint pain related to age-related wear and tear.
Rheumatoid arthritis: an autoimmune disease causing painful and swollen joints in the hand and wrist and loss of joint function.
Sprains and Strains: A sprain occurs when the tissues that connect two bones are injured. A strain involves an injury to a muscle or tissue that attaches a muscle to a bone. Symptoms include bruising, swelling, and limited range of motion.
Wrist sprain: occurs when ligaments in the wrist stretch beyond their limit or tear. Symptoms include a popping or tearing feeling in the wrist, bruising, swelling, tenderness and warmth in the wrist, and loss of motion.
Trigger finger: occurs when one or more fingers or the thumb become stuck in a bent position. It can also involve nodules on the affected tendon.
De Quervian’s Tenosynovitis: caused by repetitive motion, this condition affects thumb mobility with pain occurring where the thumb meets the wrist.
Physical Therapy for Wrist and Hand Injuries
Physical therapy is an effective treatment for wrist and hand injuries. It’s important to address hand and wrist pain early for a faster recovery. The physical therapist can help control swelling and inflammation as well as restore range of motion, strength, and ability in the wrist and hand safely and gradually.
The physical therapist begins treatment with a thorough evaluation of the shoulder, elbow, wrist, and hand, using specific tests to assess range of motion and strength in the arm, wrist, and hand. The therapist also measures the hand’s grip strength and flexion of the wrist to evaluate symptoms and assess areas of weakness and pain.
Physical therapy treatment for wrist and hand injuries can include:
Pain management: use of ice to alleviate pain or the use of a wrist brace or finger splint to restrict movement while the injured tendon or muscle heals. If pain is arthritic, heat may be used to ease joint pain.
Manual therapy: soft tissue joint mobilization and massage to decrease pain, restore movement in the hand and wrist, and gently stretch the wrist and hand.
Range-of-motion exercises: used to reduce stiffness and regain full range of motion in the hand, wrist, and forearm.
Strengthening exercises: specific exercises that target the patient’s areas of weakness in the shoulder, elbow, and wrist.
Patient education: ergonomic instruction for protection of the wrist and hand when engaging in repetitive tasks and reducing excessive force on the wrist and hand during certain activities.
Functional training: functional movement training for proper wrist mechanics for work or sport-related tasks.
At Mangiarelli Rehabilitation, we have added a dedicated space for industrial rehabilitation, including testing and therapy equipment to assess and address work and sport-related wrist and hand injuries. The addition of the BTE PrimusRS testing equipment allows our therapists to not only objectively measure a patient’s wrist and hand ability and progress from the time of injury to return to work or sport, but also provides specific data-driven tests and programs to improve the patient’s ability.
Wrist and hand injuries can be debilitating when acute and become chronic when ignored. We use our hands and wrists day in and day out for daily tasks, work, and sport, placing excessive force and repetition on these complex and delicate structures. If you are experiencing wrist or hand pain, get relief now. Work with our physical therapists to restore strength and reduce pain to return to work and sport pain-free!
