Carpal tunnel syndrome occurs when the Median nerve gets compressed or inflamed as it passes through the carpal tunnel at the wrist. It usually results in pins and needles or numbness in the thumb, index finger and middle finger and is commonly worse at night time. Other symptoms include pain in the palm and reduced gripping capacity. Activities that can lead to carpal tunnel syndrome include highly repetitious gripping tasks, leaning on wrists for long periods of time (e.g. when typing), frequent exposure to vibration such as power tools or sleeping with fists clenched and wrists curled. There is good evidence that the correct wrist resting splint worn at night and completing nerve gliding exercises can help symptoms.
“Tennis elbow” or Common Extensor Origin Tendinosis, is a commonly occurring condition where the tendon on the lateral side of the elbow gets inflamed and over time slowly degenerates. It results in pain at the tendon attachment site at the elbow and often with pain into the muscles of the forearm. People with this condition experience pain while gripping objects which is worse with reaching and gripping. Hand therapy treatment and a graded exercise program can facilitate the tendon healing process but it is usually a condition that lasts several months or more.
Shoulder bursitis and rotator cuff tendon problems are usually linked together and sometimes referred to as “Impingement syndrome”. Commonly on ultrasound we see that the bursa (a soft tissue structure within the shoulder joint), gets inflamed and swells, this can flick across the ligaments as the arm is moved to shoulder height. The tendons of the rotator cuff muscles get inflamed and can develop small tears, usually from repetitive reaching activities. Physiotherapy treatment aims to reduce pain and swelling and restore the balance of the rotator cuff muscles through gentle strengthening.
De Quervain’s Tenosynovitis is another common condition that we treat in hand therapy. It is usually caused by tasks that require repetitive pinch gripping or pushing with the thumb or lifting thumbs while deviating the wrists. It can lead to inflammation of the lining around two of the thumb tendons. Pain and swelling can be felt at the base of the thumb and at the wrist. Treatment can include a custom-made thumb and wrist resting splint for a period of immobilisation and a graded progression of exercises.
The wrist is a very complex structure with 15 bones coming together to form multiple joints at the wrist along with combined ligament structures, muscles and tendons. Wrist pain can be caused by many factors such as joint instability, ligament/cartilage tears, degenerative joint conditions, fractures, tendon inflammation and the like. A thorough assessment by a hand therapist is recommended to determine the cause of the pain and the most appropriate treatment.
Both Rheumatoid arthritis and Osteoarthritis are commonly seen in joints of the hand. Arthritis can be both painful and limiting in the functional use of the hands as it can lead to joint deformity and stiffness with time. Hand therapy treatment can include specific exercises, advice on what activities to avoid, guidance with ergonomic tools and equipment for use at home or work and fabrication of custom-made splints both for resting positions, functional activities and sometimes to assist to correct or prevent deformity.
Fractures and dislocations of the joints of the fingers and hand are commonly seen from sports injuries or other high-impact injuries. Early assessment (and X-ray), are necessary to allow the bones to be positioned correctly for best healing and alignment. For some fractures this can be done with splinting while others will require surgery to insert plates and screws. Hand therapy is important for splinting and swelling management, advice on activity modification and appropriate exercises to avoid stiffness and regain joint motion and hand strength. We can also make protective guards (splints) for sport.