The wrist is a dense combination of muscles, ligaments and bones and is one of the most frequently injured body parts! Wrist pain or injury can occur as a result of sporting injuries, work injuries or everyday use and its pain can limit daily activities, sleep or even exercising. An accurate diagnosis is crucial to the correct management of wrist pain.
Your physiotherapist will do a full subjective and objective assessment of your hand and wrist considering a wide range of factors including referred pain from the upper arm or neck, the mechanics of the whole arm, strength, posture and desk set up. They will assess the small bones that comprise the wrist individually, as well as checking how they move in relation to their neighbours, the quality and the range of the movement.
Treatment of your wrist pain may include strengthening exercises, manual therapy to unload any tight muscles or stiff joints, dry needling, modification of exercises (push ups, planks etc) or desk setup.
Tendinitis
Tendinitis is very common in the wrist and hand, particularly in desk users, musicians and with home renovation (painting, tiling, paving etc)! Tendonitis is by definition, inflammation of the tendons of the wrist caused by an overload. Put simply, the tendon has been injured at a rate higher than it is able to heal and thus it has become inflamed, swollen and sore.
Treatment of tendonitis is always multi-faceted. The most important part of the treatment is to identify where the overload came from. If it was a large painting job that has now be completed then this is now less important, but if the overload has come from prolonged desk use with a poorly set up mouse or keyboard then this is most important. No amount of physiotherapy can unload a hand that spends 12 hours on a mouse, 5 days a week that is not ergonomic and placing uneven load on the muscles and tendons of the wrist and hand.
Treatment of the tendonitis itself may include splinting or taping for temporary immobilisation, ultrasound, soft tissue release and specific strengthening exercises. We may also recommend a formal desk assessment, trialling different keyboards/ mouse, standing desks, modification of monitor height etc to unload the upper limbs and restore good ergonomics.
Dequervain’s tenosynovitis
Dequervain’s tenosynovitis is the most common wrist tendon injury that we see at City Physio. It is an injury to the thumb tendons at the wrist and is often caused by too much side-to-side movement of the hand and thumb. This can occur slowly over time with prolonged desk work particularly if the keyboard it not ergonomically set up. If the wrists sit on the desk and the hands pivot from this point the tendons on the sides of the hands can become overloaded with time. We have also seen it come on it a very acute fashion after prolonged painting with a brush, production line or construction work, and with pouring of a large, heavy pot to the side (as though pouring pasta or a casserole into another bowl).
Treatment of De Quervain’s Tenosynovitis is always multi faceted. The most important part of the treatment is to identify where the overload came from. If it was a large painting job that has now be completed then this is now less important, but if the overload has come from prolonged desk use with a poorly set up mouse or keyboard then this is most important. No amount of physiotherapy can unload a hand that spends 12 hours on a mouse, 5 days a week that is not ergonomic and placing uneven load on the muscles and tendons of the wrist and hand.
Treatment of the injury itself may include splinting or taping for temporary immobilisation, ultrasound, soft tissue release and specific strengthening exercises. We may also recommend a formal desk assessment, trialling different keyboards/ mouse, standing desks, modification of monitor height etc to unload the upper limbs and restore good ergonomics.
Arthritis
Hand and wrist osteoarthritis is a common source of hand and wrist pain with aging. Everyday wear and tear can damage the joints over time. This is very common with excessive weight-bearing exercises such as with boxing or gymnastics, and with repetitive movements such a knitting or crochet work.
Osteoarthritis or degenerative joint disease affects a large number of the population and can be well managed by maintenance physiotherapy and a prescribed exercise program. Osteoarthritis is one of around 100 different arthritis types but is by far the most common.
Osteoarthritis, in essence, is wear and tear in joints and research indicates that up to 90% of people will have some type of osteoarthritic changes occurring in their weight bearing joints by the time they are 40! Joints can be damaged at work, during sport or with repeated activities and different joints are impacted depending on posture, injury history and potentially even genetics. The most commonly affected joints are the spine, hip and knees.
Physiotherapy treatment provides a non-medication option to restore range, reduce inflammation and increase or preserve joint function. A thorough assessment will be made of the joints impacted, the range of motion, balance of strength around the joint as well as above and below it, swelling and pain levels etc. Treatment may include joint mobilisation, specific exercise prescription, dry needling, taping or bracing.
A home exercise program if done regularly will assist in reducing osteoarthritic flare ups. Additionally, a maintenance physiotherapy session every 4-6 week has been found to be very effective in preserving joint range and increasing compliance with the exercise program! The program can also be modified and added to as range and strength changes with time.
Muscle strain
The most common source of muscle pain is a muscle pain due to a pulled muscle or a muscle tear. A muscle strain can vary in severity from a very mild overstretch to a complete muscle rupture or tear.
Muscle strains occur most frequently with speed, such as when running or kicking a ball. This is most common with leg muscle strains to the hamstring or quadricep muscles. The muscles extend beyond their limits at speed can this can cause damage to the fibres as they overstretch or tear.
Muscles can also be susceptible to fatigue related strain such as a back or neck strain with postural fatigue. Another common source of muscle pain is excessive loading of a muscle with excessive exercise. Exercise causes microtrauma to muscles, which gives a sensation of delayed onset muscle soreness, or DOMS.
Other common muscle injuries such as overuse injury or RSI can result from a combination of postural fatigue and an overuse of the smaller upper limb and arm muscles over time.
A muscle strain can present with tightness, some bruising, weakness and an inability to fully stretch a muscle. The more sever the strain, the more significant the symptoms.
Your physiotherapist will do a full subjective and objective assessment of your muscle pain considering a wide range of factors including referred pain, the mechanics of the whole limb, strength and balance of the muscles surrounding, sporting technique, motor control, core stability and biomechanical analysis.
Sprained ligaments
Sprained ligaments occurs when the ligaments are stretched beyond their limits or even torn. This is most common in ankle and wrist sprains which can vary in their severity from a mild rolled or twisted ankle, to a severe sprain with complete ligament ruptures, fractures and tendon damage.
The most common causes of sprains are rolling the ankle on uneven ground or a fall causing someone to hand heavily on their hand or arm. or landing on an uneven surface. Others can occur with a misstep in high heels, a sporting mishap or other lifting injury.
At the time of injury you will often have a sudden onset of pain, swelling and heat. In most cases you should be able to move the joint with pain, but in more severe sprains an xray may be needed to rule out a fracture.
The first treatment for an sprain injury will involve a detailed history of how the injury occurred, the sports and activities played. The physiotherapist will do a physical exam to determine what ligaments have been injured, to what extent and if any other muscles or soft tissues have also been injured. From this, the Physiotherapist will determine an appropriate action plan to not just reduce pain, but to prevent recurrence, eliminate or control and contributing factors and return the athlete back to sport in the fastest, most efficient way!
Our physiotherapists will do a full subjective and objective assessment of your sprain considering a wide range of factors including referred pain, strength and balance of the muscles surrounding the joint, sporting technique, motor control, hobbies and pain level.