Your hand and wrist joint are paramount to everyday life and an injury to this area can be extremely disabling, causing not only pain and discomfort but also significant functional limitations.

Injuries to the wrist area can also be psychologically challenging. Think about how you would cope without having full use of your hand or wrist when performing everyday activities such as cooking, eating, texting, writing, driving and even getting dressed.

The wrist is a complex joint with a group of eight bones, known as the carpals, sitting on top of the forearm bones (the radius and ulna). Extending out from the carpals forming our fingers are the phalanges — there are three of these per finger!

Within the hand, wrist and forearm there are many muscles and nerves that work together to give strength and allow us to perform very specific tasks with our hands, known as fine motor skills. When looking at the most common wrist injuries, there are two main categories — sudden acute injuries and gradual overuse/loading injuries.

Acute injuries can occur from trauma such as a direct blow, fall onto the hand or a sudden awkward force onto the joint. Acute injuries are usually associated with bruising and swelling soon after the initial injury.

Common acute injuries include:

Finger (proximal interphalangeal joint) dislocations

Dislocations of the finger are commonly associated with sports-related injuries and occur when a sudden force impacts the end of the finger, often seen in ball related sports.

Management often focuses on assisting healing of the injured the soft tissues (ligaments and tendon) and can include period of bracing and immobilisation followed by rehabilitation to help regain the full range of motion and strength.

Fractures

Fractures or broken bones are caused by a direct force or trauma to the hand/wrist and will need to be managed with a period of immobilisation (splint or cast) and in some cases may require surgical intervention. Once the bone is healing well and you have been given the okay by your doctor to start using your hand, it is important to work through appropriate exercises, as well as to get education to help you slowly return to sport and work-related activities.

Overuse/overload

Load-related injuries are associated with a period of change in activity load (increase in repetitions, weight, postures or duration) of the hand and wrist. Below of some of the most common:

• RSI (repetitive strain injury)/tendinitis/tenosynovitis
  RSI is a general term for non-specific injuries caused by repetitive movements or change in activity load. The importance though is further diagnosing the irritated tissue, making changes to help settle it and then modifying the activity or activities that caused it. The conditions of tenosynovitis and tendonitis are more specific and helpful when diagnosing and managing your wrist pain.
• Tendinitis of the wrist tendons is usually associated with trauma to the tissue followed by an inadequate period of rest to let it settle.
• Tenosynovitis is a result of the sheath covering the tendons (synovial sheath)becoming inflamed due to a change in activity or load. The change of the demand results in friction between the tendon and sheath, causing inflammation and pain.

Carpal tunnel syndrome

The carpal tunnel is a space in the wrist where one of the main nerves of upper-limb known as the median nerve passes through into the hand as well as muscles and tendons from the forearm pass through to attach onto fingers. The median nerve can become compressed or irritated if there is a change to carpal tunnel shape or through inflammation.

It is common to not only feel pain, but also changes to the sensation of the thumb, middle and index finger (numbness, pins and needles). Treatment initially involves reducing irritation through activity modification and splinting. Once symptoms are settled, identification of the initial cause and then modifying that activity and building up strength and range can help prevent reoccurrence.

De Quervains (De Quervain’s tenosynovitis)

De Quervain’s tenosynovitis is associated with pain and inflammation of the thumb and the thumb side of the wrist. The condition is caused by friction of two thumb tendons post repetitive compression or increased use of the thumb tendons. This is often seen in new parents who are repetitively picking up a baby or in the gaming population after the release of the latest FIFA.

Management focuses on activity modification to avoid overuse and compression, splinting to prevent irritating postures and to allow for the inflammation to settle.

Life Ready Physio — comprehensive, personalised physiotherapy for pain-free living

With close to twenty locations across Australia, Life Ready Physio is a physiotherapy and Pilates group with a passion for giving you the mobility to live your very best life. With physiotherapy services including injury management, Clinical Pilates, gym rehabilitation, hydrotherapy, exercise physiology and remedial massage therapy, we aim to raise the bar of the healthcare industry while bringing you the pleasure of a pain-free lifestyle.

Should you have a wrist injury or anything else that requires skilled treatment, please get in touch with one of our specialists to make a booking. Or, if you’d like some more information on the services we offer, click here.

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