Background

Background

The ulna and radius make up the forearm bones. These bones attach to the 8 small carpal bones that create the wrist. These bones allow the wrist to bend up and down, in and out, and perform large circular motions. There are many ligaments that attach between each bone to provide stability to the wrist. The palm is made up of metacarpal bones, which are long bones that attach the wrist to the fingers. Within the palm are muscles that allow incredible dexterity at the fingers and especially the thumb. Many small muscles and ligaments come together to allow for fine motor control in daily activities.

Diagnoses

Wrist Fracture


The common mechanism for a wrist fracture is falling on an out stretched hand (FOOSH). The most common structures to become fractured are the ulna, the radius, and the scaphoid bones. Another mechanism, but less common, can be caused by punching a hard surface, called a Boxer’s fracture, in which a metacarpal bone, likely the 5th metacarpal, is fractured. Most fractures require bracing, casting, or splinting to allow for full healing prior to physical therapy. Once the bone is healed and physical therapy is deemed appropriate, it will be important to quickly regain the motion of the joints. The physical therapist will be able to safely progress range of motion and strength in the joint surrounding the fracture site to allow a safe return to daily activities.

DeQuervain’s Tenosynovitis

Overuse injuries in the hand and wrist are very common, especially with increased use of computers and cell phones. One overuse injury, DeQuervain’s tenosynovitis is characterized by inflammation and irritation of the sheath’s of tendons around the thumb. The sheath surrounding the tendon normally allows for smooth movement. When it becomes inflamed due to overuse, activities such as texting, gripping, and writing become painful. The initial goal of physical therapy is to reduce inflammation and irritation of the tendon and tendon sheaths. This can be accomplished with modalities such as ultrasound or electrical stimulation as well as with a brace or splint. The physical therapist will also work on the ergonomics of work stations and daily activities to reduce stress to the tendons. Strengthening and stabilization throughout the hand and arm will also play a role in therapy.

Carpal Tunnel Syndrome

A common diagnosis for wrist and hand pain is carpal tunnel syndrome (CTS). CTS can present with pain across the wrist as well as numbness and tingling of the thumb and first two fingers. Symptoms are exacerbated with extreme bending or extending of the wrist as well as gripping and repetitive motions. CTS occurs because of a narrowing of the space across the wrist bones called the carpal tunnel. Many tendons and nerves run through this area. When the space is narrowed, it places pressure on the nerves resulting in pain and altered sensation. One of the most effective treatments for CTS is bracing of the wrist, especially while sleeping. This reduces the extreme postures of the wrist and reduces over activation of the muscles. Along with bracing, modalities such as ultrasound may be used to reduce swelling. Strengthening of the wrist muscles and shoulder muscles also is important for full recovery. 

Carpometacarpal Joint (Thumb) Arthritis

The Carpometacarpal (CMC) joint of the thumb is one of the most common joints to have arthritic pain (1). This joint is at the base of the thumb where it connects to the wrist. Symptoms of CMC arthritis is pain with fine motor movements such as writing, texting, or knitting as well as gripping activities. If symptoms are severe a physician may recommend a cortisone steroid injection to reduce inflammation. Bracing or splinting of the thumb can be helpful to reduce over activation of the thumb and decrease inflammation. For long term management it is important to strengthen the muscles around the thumb. Improving the biomechanics of gripping activities can greatly reduce the stress onto the CMC joint. Physical therapy will focus on reducing the inflammation as well as implementing a strengthening program for the surrounding areas.