Elbow/Wrist/Hand Pain

Causes For Pain in Wrist and Hand

If you’re experiencing pain in the wrist and hand, there could be several reasons as to why. Common injuries like carpal tunnel syndrome as well as conditions like rheumatoid arthritis can cause pain in the wrist and hand. Find out more about the potential source of your pain and how to treat it below.

Guide to Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition of the wrist and hand that can affect the use of the whole arm. It is caused by pressure on the nerve at the base of the palm (median nerve). Because of the demands that people place on their hands and wrists, CTS is a common condition affecting 1 out of 20 Americans and can cause pain in the wrist and hand. Surgery for this condition is commonly performed on the wrist and hand. Fortunately for most people who develop CTS, physical therapy treatment can often relieve pain and numbness and restore normal use of the hand, wrist, and arm without the need for surgery.

What is Carpal Tunnel Syndrome?

About the width of your thumb, the carpal tunnel is a narrow channel on the palm side of your wrist. The tunnel protects the median nerve and the tendons that bend your fingers. Pressure on the nerve can cause weakness and pain in your wrist and hand and numbness or tingling in some of your fingers. This pressure is caused by crowding or irritation of the median nerve in the carpal tunnel and can lead to CTS.

Causes of Carpal Tunnel Syndrome

CTS is a common cause of pain in your wrist and hands. Driving a vehicle or using machinery that vibrates will aggravate the symptoms of CTS.  Excessive keyboard and computer use can cause CTS, but people who work in jobs like meatpacking and assembly line work are especially prone to developing CTS. Sports like racquetball and activities like sewing and playing the violin can also cause you to develop CTS. If you experience pain in your wrist or hand that doesn’t go away, physical therapy can help ease the pain.

The following health conditions can also lead to CTS in some individuals:

• Inflammation and swelling of the tendons of the wrist
• Injuries to the wrist (strain, sprain, dislocation, fracture)
• Hormone or metabolic changes (pregnancy, menopause, thyroid imbalance)
• Fluid retention (eg, during pregnancy)
• Diabetes
• Certain medicine use (eg, steroids)
• Degenerative and rheumatoid arthritis

Signs and Symptoms

CTS usually starts gradually, with symptoms such as burning, tingling, “pins and needles,” or numbness in the palm and fingers. Often the symptoms are more noticeable during the night, and individuals often report being wakened with symptoms. Many people feel the need to “shake out” their hands to try to relieve the symptoms.

As the condition progresses, the symptoms are noticed during the daytime and are often worse when holding items such as a heavy book or a hairbrush.  A weakness of the hand and more constant numbness may occur if the pressure on the nerve continues. You may find that you drop objects unexpectedly or a weak grip. You may also experience pain in your wrist and hand.

How Is It Diagnosed?

Physical therapists are experts in the movement and function of the body and will work closely with other health care professionals to accurately diagnose and treat CTS. Symptoms of CTS are typical, and it is often possible to diagnose it without extensive testing.  Some tests that may be used to help diagnose CTS include:

• Examination of your neck and entire upper extremity to rule out other conditions. Many patients have been told they have CTS, only to find out that the pain is coming from another body part.
• Grip strength of fingers and thumb
• Sensory tests
• Wrist and hand range-of-motion
• Wrist flexion (Phalen) test: Your physical therapist will have you push the backs of your hands together for 1 minute. Tingling or numbness in your fingers that occurs within 60 seconds may be an indication of CTS.
• Tinel’s Sign: Your physical therapist will use a reflex hammer or finger to tap over the median nerve at your wrist. Tingling in the thumb and index and middle fingers may indicate CTS.
• Electrical studies (electromyogram/EMG) and nerve conduction velocity (NCV): These tests determine the transmission of the nerve and the severity of the CTS.
• X-rays: When trauma has occurred, or if there is a reason to suspect anatomical abnormality, x-rays may be ordered.

In some cases, your physical therapist may refer you to a physician or other health care professional for additional testing or treatment.

How Can a Physical Therapist Help?

After the evaluation, your physical therapist will prescribe your treatment plan based on your specific case. If your evaluation confirms early-stage CTS, your therapist will recommend conservative care as a first step. Physical therapy treatment can be effective in reducing your symptoms so you can perform daily tasks without pain.

Conservative Care

Depending upon the causes of your CTS, your therapy program may include:

• Education regarding changing wrist positions, proper neck and upper back posture, safe use of sharp utensils and tools, and incorporating stretching into your daily activities.
• Exercises to increase the strength of the muscles in your hand, fingers, and forearm—and in some cases, the trunk and postural back muscles
• Stretching exercises to improve the flexibility of the wrist, hand, and fingers.
• Use of heat/cold treatments to relieve pain.
• Use of a night splint to reduce discomfort.
• Astym® Therapy
• A worksite visit to assess your work area. For example, if you sit at a desk and work on a computer, it’s important for the keyboard to be in proper alignment to help avoid working in a bent wrist position.
• Increasing the size of the tool and utensil handles by adding extra material for a more comfortable grip.
• Using anti-vibration gloves or anti-vibration wraps around tool handles if this is a factor at your workplace.

Your physical therapist will also consider your home and leisure activities, with recommendations such as wearing gloves to keep the wrist/hands warm and limiting sports that aggravate the condition, such as racquet sports, until symptoms resolve.

Physical Therapy Following Surgery

If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to a physician for a surgical consultation. If necessary, surgery will be performed to release the band of tissue that is causing pressure on the median nerve. Physical therapy treatment is important after surgery to help restore strength to the wrist and to learn to modify habits that may have led to symptoms in the first place. Your physical therapy treatment may include:

• Exercises to improve the strength of the wrist/hand muscles and improve function.
• Stretching to improve mobility of the wrist/fingers and improve function.
• Scar management to keep the skin supple and flexible.
• Education regarding appropriate posture and wrist position to avoid carpal tunnel compression in-home/leisure activities.
• A worksite visit or simulation to optimize postures and positions.

Guide to Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects approximately 1% of the United States population. RA often results in pain and inflammation in joints on both sides of the body and can become disabling due to its effect on the immune system. A physical therapist can help manage the symptoms of RA, enhancing an individual’s quality of life.

What is Rheumatoid Arthritis?

RA is classified as an autoimmune disease—a condition where the body’s immune system attacks its tissues. Although the exact cause of RA is not known, doctors have proposed several theories to identify who is most likely to develop it. The cause may be related to a combination of genetics and environmental or hormonal factors. Women are more likely to develop the disease; women are diagnosed with RA 3 times more than men. Although RA may begin at any age, most research suggests it often begins in midlife.

How Does it Feel?

RA symptoms can flare up and then quiet down (go into remission). Research shows that early diagnosis and treatment is important for easing symptoms and flare-ups.

RA symptoms can flare up and then go into remission. During a flare up, with RA may experience:

• Stiff joints that feel worse in the morning.
• Painful and swollen joints on both sides of the body.
• Bouts of fatigue and general discomfort.
• Fever.
• Loss of joint function.
• Redness, warmth, and tenderness in the joint areas.

How Is It Diagnosed?

A rheumatologist generally diagnoses RA, and research shows that early diagnosis and treatment is important for easing symptoms and flare-ups. A variety of factors determine the diagnosis, such as inflammation of the tissues that line the joints, the number of joints involved, and blood-test results. A physical therapist may be the first practitioner to recognize the onset of RA; the physical therapist will refer an individual with suspected symptoms to an appropriate clinician for further tests.

How Can a Physical Therapist Help?

Physical therapists play a vital role in improving and maintaining function that may be limited by RA. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals. Because the signs and symptoms of RA can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

• Aerobic Activities. Studies have shown that group-based exercise and educational programs for people with RA have beneficial effects on individual strength and function.
• Goal-Oriented Exercise. Studies also show that the achievement of personal physical activity goals helps reduce pain and increase the general quality of life in people diagnosed with RA.
• Modalities. Your physical therapist may use modalities, such as gentle heat and electrical stimulation to help manage your RA symptoms.

Guide to Wrist Tendinitis

Wrist tendinitis, not to be confused with tendinosis, is a condition that most commonly occurs in individuals who perform repetitive activities using the hand and arm. These include computer users, factory workers, and athletes who throw and catch balls and play racquet sports. A top cause for pain in the wrist and hand, some wrist tenditis facts include:

• In the United States, the incidence of tendinitis as an occupational injury in people who work full time is 1.1 per 100,000.
• Overuse tendinitis is responsible for 25% to 50% of all sports injuries in the United States.
• Older individuals are often more at risk for wrist tendinitis due to a loss of elasticity in the wrist tendons.

Physical therapists help people with wrist tendinitis reduce their pain, increase their wrist flexibility and strength, and return to their previous functional activities and sports.

What is Wrist Tendinitis?

Wrist tendinitis is a condition where 1 or more tendons in the wrist become inflamed and irritated. There are several tendons in the wrist that connect the muscles of the forearm and hand to the bones of the wrist and hand. These tendons are the small rope-like structures that you can see connecting to the fingers on the back of your hand. There are a number of conditions that can affect the tendons in this area.

• Wrist tendinitis applies to the early stages of tendon inflammation and irritation.
• Tendinopathy is the name given to the condition when it persists over time, is not treated, and becomes chronic.
• Tenosynovitis is the term given to an irritation that develops when the synovial sheath (through which some of these tendons glide) thickens and restricts the tendon.
• De Quervain’s Tendinitis applies to tendinitis that develops on the thumb side of the wrist.

How Does it Feel?

Several tendons in the wrist can become irritated with wrist tendinitis, which can cause pain in the wrist and hand. Pain symptoms associated with the condition include:

• Pain where the arm meets the hand, which can radiate up into the elbow.
• Pain on the thumb side of the wrist (radial) or the little-finger side of the wrist (ulnar).
• Pain that only occurs when the wrist is under strain, which can become constant pain when left untreated.
• Pain when putting pressure on the hand, such as using the arms to push yourself up out of a chair to stand.

Besides pain, other symptoms include:

• Stiffness of the wrist, and a decreased ability to bend and extend the wrist.
• Inflammation or swelling in the wrist area.
• Tenderness to touch in the wrist and/or forearm muscles.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation of your entire arm to include the shoulder, elbow, wrist, and hand. The therapist will ask you to describe the types of activities you normally perform using your arm at home, at work, and for recreation, and which of these activities causes pain or stiffness in the area. They’ll also want to know how long the pain has been occurring and how it is affecting your regular activities of daily living.

A physical exam will include testing your range of motion and strength in your entire upper arm. Your therapist will gently touch specific areas of your wrist and forearm to determine which wrist tendons are involved and to check for any swelling in the area.

How Can a Physical Therapist Help?

Physical therapy is a highly effective treatment for wrist tendinitis. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your treatment program may include:

• Pain Management. Your physical therapist will help you identify and avoid painful movements, and show you how to correct abnormal postures to reduce stress on the wrist. Initially, they may recommend resting the wrist short-term and applying ice to the area to help alleviate pain. Your physical therapist also may apply a wrist brace to restrict wrist movement, allowing the tendons to heal.
• Manual Therapy. Manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches can be used to get your wrist moving properly.
• Range-of-Motion Exercises. You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.
• Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific areas of weakness. The entire arm, including the shoulder, elbow, and wrist, can potentially be weakened and contribute to the movement dysfunction that causes tendinitis. An individualized home exercise program will be designed to meet your specific needs and goals, which you can continue long after you have completed your formal physical therapy.
• Patient Education. Depending on the specific activities you plan on resuming, your physical therapist will teach you ways to perform actions, while protecting your wrist and hand. For example, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.
• Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform functional movement patterns using proper wrist mechanics, such as typing on a computer or swinging a racquet. This training will help you return to pain-free function on the job, at home, and when playing sports.

Treat the Pain in Your Wrist and Hand

Make your day-to-day life easier and more comfortable by treating the pain in your hand with IMPACT Physical Therapy. We have friendly and informed physical therapists at multiple locations to make seeking treatment convenient. Connect with us today to get started!