The hand and wrist are certainly one of many complex structures in our body. Given the importance of our hands and their role in facilitating our everyday tasks and activities, it is essential to have your injury or symptoms addressed at the onset of your symptoms.
This article will briefly outline some of the common presentations and give a brief description of how to manage them. It is important to seek the advice and assessment of a Hand Physiotherapist to ensure you are receiving the highest level of care.
The Anatomy of Your Wrist and Hand
Firstly, if we take a look at the wrist, it contains many small bones neatly joined together by ligaments. This area is commonly referred to as the Carpus. We have our two main forearm bones, the radius and ulna connecting with the wrist from one end. The other end of the carpus is where our finger and thumb bones join, our metacarpals and the ends of our fingers called phalanges. Our thumb contains a proximal and distal phalanx, and the 2nd to 5th digits contain a proximal, middle and distal phalanx.
Each bone in the carpus has a specific name and the joint spaces between each of these carpal bones has a unique name. For example, the carpal bones scaphoid and lunate form a unique joint called the scaphoid-lunate joint. This joint also shares ligaments that help maintain the stability of the joint. The joints between our metacarpals and phalanges are call metacarpal-phalangeal joints (MCPJs) and the joints between our phalanges are called proximal interphalangeal joints (PIPs) and distal inter-phalangeal joints (DIPs).
We have a number of tendons and muscles that either traverse the top or bottom of the wrist and or digits and accompanying these are nerves and blood vessels.
When we look at types of injury, we can very loosely divide them into two categories; a traumatic presentation and an overuse condition.
Typically with traumatic injury, we generally feel symptoms immediately and generally, these symptoms immediately follow a particular movement or mechanism of injury.
An overuse injury, refers to symptoms that have developed over a period of time, whether the symptoms stay the same or gradually change. This article will give a brief overview for each of these categories for most common hand and wrist presentations.
One common mechanism of injury for the wrist is falling on an outstretched hand. This is a common occurrence out on the football field, tripping over when walking or coming off a bike. Structures that are commonly injured include:
- a fracture of the distal radius / ulna
- scaphoid fracture
- scapho-lunate ligament tear / / scapho-lunate dissociation (separation)
- Triangulo-fibrocartilaginous complex tear (TFCC)
Each of these structures will require a period of immobilisation in a particular position prior to commencing rehabilitation to restore movement and strength to the hand and wrist.
Wrist pain can also occur after repeating a movement for a prolonged period of time, or vigorous repetitions with force. Some of the conditions that can occur include:
- Carpal Tunnel Syndrome
- De Quervain’s Tenosynovitis
- Intersection Syndrome
- Tenosynovitis or synovitis of the extensor or flexor tendons at the level of the wrist and forearm
Management of these conditions would typically involve splinting into a specific position for a period of time with regular tendon gliding exercises, icing of the affected area. Once the symptoms have begun to subside, weaning from the splint is introduced and gradual strengthening and movement exercises are prescribed.
When we look at common traumatic injuries to the thumb and digits, the following presentations come to mind:
- fractures of the metacarpals and phalanges
- dislocations of the PIP and DIP joints (most commonly)
- collateral ligament tears to the base of the thumb (MCP joint)
- collateral ligament tears to the PIP joints of the thumb
- volar plate injuries
- avulsion fractures of the DIP joints
Each of these injuries require specific positioning for varying periods of time to enable tissue healing and then rehabilitation of movement and strengthening will follow.
Overuse injuries of the extremities include:
- tendinitis / tenosynovitis / synovitis of the flexor tendons at the level of the digits
- MCP joint and CMC joint degeneration
- MCP joint instability
- Trigger finger
- Trigger thumb
- Wear and tear of the PIP joints and DIP joints of the fingers
Similarly, most of these areas will require splinting for periods of time to ensure protection of the joint surface or rest of the inflamed area. Careful prescription of movement exercises, tendon gliding exercises, icing inflamed areas and controlled strengthening are all likely to be part of the rehabilitation phase.
Whether in an acute or more chronic presentation, depending on the severity, deformity, deviation and integrity of surrounding structures, other measures will be taken to ensure the best outcome for the individual. Some of these things include imaging, cortisone injections, or referral to a Specialist for surgical intervention.
If you have an ache or a pain, no matter how little, be sure to put your health first and consult your Hand Physiotherapist today.