Wrist Pain

Our wrists are made up of 8 carpal bones and a intricate web of nerves and ligaments. These 8 bones support an area called the carpal tunnel. This tunnel contains tendons and the median nerve.

One of the most common sites of injury is the wrist. The wrists are used in a variety of different sports such as badminton, tennis, boxing and are also extensively used when we type and in certain occupations. This repetitive motion of certain activities makes some people more susceptible to wrist pain.

The majority of falls also result in wrist pain as we naturally outstretch our hands to cushion our fall.

Introduction

A wrist sprain is stretching or tearing of the ligaments that support the wrist. Ligaments are strong bands of tissue that connect bones to each other. This often occurs due to a fall on an outstretched hand which causes ligaments to stretch which can be very painful. Pain will be present around the wrist and there may be some redness and bruising. The patient will complain of limited range of movement.

A wrist sprain can be classed in three different grades:

• Grade 1 Sprain: Micro tear of the ligaments
• Grade 2 Sprain: Partial tear of ligament and mid-joint instability.
• Grade 3 Sprain: Severe or complete tear of ligaments and significant joint instability.

Cause

• Accidental fall
• Muscle weakness
• Inappropriate wrist guards
• Playing certain sports such as ice volleyball, squash, badminton, football and basketball are higher risk sports associated with this condition.

Treatment

• R.I.C.E: Rest (Avoid using your injured wrist and hand), Ice (Apply ice or a cold pack to the wrist for 15-20 minutes, 4 times a day for several days, Compression (Wrap your wrist in an elastic support, this will limit swelling and support your wrist) and Elevation ( Keep the injured wrist raised above the level of your heart for 48 hours such as up on a pillow this will help drain fluid and reduce swelling).
• Pain Killers (please consult your doctor for advice regarding appropriate pain killers).
• Wrist Braces
• Surgery may be required if the ligament is completely torn or their is an associated fracture.
• If the sprain is very severe the wrist may be casted for a weeks to immobilize the area to allow healing.

Rehabilitation

Rehabilation exercises and wrist braces will help speed up recovery and prevent further injury.You may need to wear a brace to immobilize your wrist. If you play sports, you may need to wear a wrist brace or tape your wrist when you return to play.

Arthritis Wrist

Introduction

Arthritis of the hand and wrist occurs in one of two major forms: inflammatory arthritis, including conditions such as rheumatoid arthritis, and the more common form of degenerative arthritis is known as osteoarthritis. Osteoarthritis is the main form of arthritis and is known as the “wear and tear” disorder. It can affect any joint. The wrist is especially susceptible due to the tremendous amounts of pressure that is placed during everyday activities. Osteoarthritis causes the cartilage to erode and then causes the bone ends to rub against each other which results in stiffness and aching of the joints.

Rheumatoid Arthritis is a systemic disease, which affects the whole body. In rheumatoid arthritis, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. Rheumatoid arthritis can affect all the joints and muscles in the wrist. It affects more women then men and can be inherited. The insides of the joints become swollen and stiff. It affects the wrist by causing stiffness, swelling, and the loss of motion. One common symptom of rheumatoid arthritis of the wrist is diminished grip strength. The fingers of the hand are able to move because of the connection of tendons within them to the muscles of the forearm.

There is another form of arthritis that you should be aware of called infectious arthritis. Infectious arthritis (septic arthritis) is infection in the fluid and tissues of a joint usually caused by bacteria, but sometimes caused by viruses or fungi. The patient will have swelling of the wrist accompanied by heat. He or she will also have fever and touching the wrist will cause extreme pain. In such as case visit your local emergency department as soon as possible. Touching the wrist will cause Extreme pain.

Symptoms

Rheumatoid arthritis

• Painful, swollen joints.
• Tendons are no longer able to work on stable joints, often resulting in an unnatural rotation of the wrist.
• Diminished grip of the fingers.

Osteoarthritis

• Stiffness and pain in a particular joint.
• Your wrist may fill with fluid and feel tight, especially after use. When all the articular cartilage is worn off the joint surface, you may notice a squeaking sound when you move your wrist. Doctors call this creaking crepitus.
• Diminished grip of the fingers.

Treatment

Osteoarthritis of Wrist

• Treatment is usually conservative, surgical intervention is rarely considered.
• Nonsteroidal anti-inflammatory drugs may be prescribed by the doctor to control the pain.
• Heat therapy and products such as cryotherepy/cold therapy are very good to alleviate discomfort.
• Wrist brace and supports will help to reduce your pain during activity. Range-of-motion and stretching exercises can improve your wrist motion. Strengthening exercises for the arm and hand help steady the wrist and protect the joint from shock and stress.

Rheumatoid Arthritis of wrist

• There is no cure for rheumatoid arthritis. In the absence of infection, cortisone injections directly to the wrist can be very helpful in relieving pain and improving flexibility.
• As with osteoarthritis, Nonsteroidal anti-inflammatory drugs may be prescribed by the doctor to control the pain.
• Heat therapy such as the reusable hot and cold pack will reduce discomfort to the wrist.
• Cortisone is a very powerful anti-inflammatory medication. When injected into the joint, cortisone can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with cortisone injections.
• Surgery is only recommended if it can stabilize the joints and deliver pain relief. Sometimes the one or more of the eight bones of the wrist may be replaced with a prosthesis, helping improve the function of the joint.
• Wrist braces and supports will reduce pain. discomfort and allow the patient to carry out daily activities in less pain.

Rehabilitation

Wrist strengthening exercises will help together with heat pads and wrist supports to reduce pain.

Carpal Tunnel Syndrome

Introduction

Carpal tunnel syndrome affects about 1 in 100 people at some point in their life. Men and women of any age can develop it, but it is most common in women in their 30s, 40s and 50s.

Sometimes carpal tunnel syndrome is triggered by a person’s occupation, and can lead to the person being unable to work. Most cases of carpal tunnel syndrome can be prevented by stopping or reducing the activity that stresses the fingers, hand, or wrist, or by changing the way in which activities are done.

Carpal Tunnel Syndrome is a condition where there is excessive pressure on the median nerve. This can be caused by swelling in the carpal tunnel and/or thickening of the transverse carpal ligament, which forms the roof of the carpal tunnel.

Pinching or compression of this nerve by the transverse carpal ligament sets into motion a progressively crippling disorder which eventually results in wrist pain, numbness and tingling in the hand, pain consisting of a “pins and needles” feeling at night, weakness in grip and a feeling of in coordination.

Symptoms

Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.

As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

Treatment

Carpal tunnel syndrome treatment usually begins conservatively, and moves to more aggressive and invasive techniques if the symptoms of carpal tunnel syndrome persist.

The initial carpal tunnel syndrome treatment steps include some medications and splints.

Doctor at A+ clinic may ask you to rest your wrist or change how you use your hand. Doctor may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

Putting ice on your wrist, massaging the area and doing stretching exercises may help too.

Cotisone injecions provide temporary relief as is it injected directly into the affectd area to decrease inflammation around the nerve.

Surgical treatments are available and effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.

Tips for relieving carpal tunnel syndrome

• Prop up your arm with pillows when you lie down.
• Avoid using your hand too much.
• Find a new way to use your hand by using a different tool.
• Try to use the other hand more often.
• Avoid bending your wrists down for long periods.

Wrist Tendonitis

Introduction

Wrist Tendonitis (DeQuervains Tendonitis) can be defined as an irritation and swelling of the sheath or tunnel which surrounds the tendons of the thumb. Typically the pain will be present at the front of the wrist. Pain will be initiated when grasping an object or pinching the fingers, Some patients present with a lump in the wrist directly above the carpal tunnel. This indicates that the condition has advanced as there may also be a balloon of joint fluid formed in that area. Localized swelling may be present and making a fist or bending the wrist will initiate pain.

Cause

• This is commonly a over use injury which results in inflammation of the lining around the tendon.
• Biomechanical condition with the wrist.
• Inappropriate technique with certain racket sport such as tennis, badminton or contact sports such as boxing.
• A fall.

Treatment

• R.I.C.E: Rest (Avoid using your injured wrist and hand), Ice (Apply ice or a cold pack to the wrist for 15-20 minutes, 4 times a day for several days, Compression (Wrap your wrist in an elastic support. This will limit swelling and support your wrist) .and Elevation ( Keep the injured wrist raised above the level of your heart for 48 hours such as up on a pillow. This will help drain fluid and reduce swelling).
• Anti-inflammatories (seek advice from doctor before commencing this treatment)
• Stretching exercises.

Rehabilitation

The exercises above will help to strengthen the wrist. Please note that these should only be attempted when the initial tendonitis has subsided and you wish to strengthen the wrist. If any pain is initiated from these exercises then you should immediately cease the exercises. Wrist supports will also help to speed up recovery and prevent further injury.

Wrist Exercise Equipment

The Ultimate Hand Helper was desinged to be comfortable, effective and versatile. The ultimate hand helper helps to strengthen the hand and wrist muscles.

Indications:

• Rehabilitation use after fracture.
• Comulative trauma injuries (sprains to tendonitis)
• carpal Tunnel Syndrome
• Arthritis