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All Posts Tagged: Wrist Pain

My wrist hurts… What is deQuervains?

Blog Post by Erika Lassig

What is deQuervains?

Pain on the thumb side of the wrist is often caused by a condition called deQuervain’s disease. Often there is no fall or injury to the hand and pain may start suddenly or begin with a small niggle that gradually gets worse. The condition was named after a Swiss physician named Fritz deQuervain.

There are two tendons that help to move the wrist and the thumb, called the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). As the APL and EPB cross the wrist they pass through a fibrous tunnel that keeps the tendons close to the forearm bone during movement. In deQuervain’s, irritation occurs at this site where the tendons pass through the tunnel, causing swelling and pain.

deQueverains occurs twice as often in women as men and frequently occurs in pregnant or new mothers. The exact cause of deQuervain’s is unknown. In some cases there is clearly an element of overuse or repetitive strain, but research tells us there are also hormonal, metabolic and degenerative factors involved. This unclear cause makes it difficult to effectively treat the condition.


What treatments are there for deQuervains?

There are a variety of treatments available. The least invasive option is hand therapy. This will often involve a resting splint or brace in more severe cases, or taping of the thumb and wrist in mild cases. Heat and soft tissue massage are also usually beneficial. Your therapist will talk to you about how to change your everyday activities to help rest the affected tendons and reduce irritation.

Most of these treatments I have listed are passive treatments, where the client can do very little but wait for the symptoms to improve. With my clients I also use some specific exercises called isometric loading exercises. In recent research studies looking at lower limb tendinopathies, isometric loading exercises have helped to reduce pain and thus aid in recovery. These exercises should not be painful and can easily be graded in intensity of the muscle contraction, duration of hold , repetition and frequency.

Other treatment options include an ultrasound-guided corticosteroid injection, which doesn’t always work long term, but effectiveness can be enhanced with the addition of hand therapy. If injection and therapy fail, there is a final option of surgical release of the fibrous tunnel, but most people wish to avoid surgery where possible.
If you think you have deQuervain’s, call us today at The Hand Recovery Centre to book an appointment.

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Carpal Tunnel Syndrome – What is it & How do I Recover?

Blog Post by Erika Lassig

Pins and needles in your hand waking you at night? Or does it come on when you’re driving the car? What about weakness in your hand or dropping objects? You may have Carpal Tunnel Syndrome (CTS). CTS affects about 2.5% of the population, which means it’s likely that you know someone who has these annoying tingles. And while lots of people have it and know what it is, not many people are aware that surgery is not the only treatment option! Let’s face it, no one wants to go under the knife if they don’t have to and the good news is that hand therapy can help! But let’s start at the beginning.

What is Carpal Tunnel Syndrome?

The main sensory nerve of the hand is called the median nerve. It supplies sensation to the thumb, index finger, middle finger and half of the ring finger. As the median nerve crosses the wrist, it must pass through a narrow tunnel formed by the small carpal bones at the bottom and a thick ligament called the transverse carpal ligament across the top. This space is called the Carpal Tunnel. Unfortunately for the median nerve, it has to share the space in the carpal tunnel with 9 tendons. And if anything happens in there to make the space a bit tight, whether that be fluid, inflammation or certain positions of the wrist, the median nerve becomes squashed. The symptoms produced by mechanical squashing of a nerve is called a nerve compression syndrome. There are several other nerve compression syndromes that occur in the upper limb, the nerves do have a long way to travel from the spinal cord down the arm and pass through various other pokey spaces along the way, but CTS is by far the most common.

Is it caused by the type of work I do?

To be honest, the jury is still out on whether particular types of work cause CTS, but if you already have some nerve compression present, then your work can most likely make it worse. There are lots of known causes of CTS. Genetic factors can contribute, with people of European descent more likely to experience CTS. In addition, diabetes, age and gender all play a role in causing the condition, with women more than 3 times likely than men to experience CTS. The majority of cases occur in people aged over 50 years. However, CTS can be made worse by poor posture, holding the wrist or hand in the same position for long periods of time, highly repetitive hand activity and vibration from hand tools and machinery such as a sander or jackhammer.
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How do I get a diagnosis?

If you suspect you have CTS, I suggest first visiting your GP and requesting a test called a nerve conduction study. This test measures how fast the nerve transmits electrical impulses at different points along the arm and can identify how severe the damage to the nerve is and also in what place the compression is occurring (e.g. at the elbow or the wrist). If the nerve compression is severe, it is important to seek treatment ASAP to minimise the risk of permanent damage to the nerve. A nerve conduction study is not essential prior to commencing therapy and if you have to wait to have the test done then there is no problem starting therapy right away. An occupational therapist or physiotherapist who is a member of the Australian Hand Therapy Association (AHTA) will be able to do a thorough assessment to determine which treatments may be the most suitable for your needs.

What will therapy involve?

Most therapists will provide a splint which limits wrist movement (and in some cases finger movement) at particular times of day or night to reduce the compression of the nerve that occurs in certain positions. The type and wearing regime of the splint will depend largely on your symptoms, body shape and your lifestyle.

Several types of exercises can be provided to help the nerve to recover from any damage that may have occurred and prevent further injury from happening. These are usually low repetition movements that result in sliding the nerve and or tendons through the carpal tunnel.

Education of the client is a very important part of therapy because it teaches you what is happening in your own body, what to do to prevent compressing the nerve and how to manage your CTS into the future should symptoms return.

Is it better to get treatment straight away or can I wait?

The longer you have had CTS, the less likely that the nerve will recover completely. You are most likely to get a full recovery if you start therapy within the first six months of noticing the problem. So don’t delay, get back to what you love sooner and call The Hand Recovery Centre to book your appointment today!

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Wrist Sprains: What You Should Know

Blog post by Erika Lassig

Picture your football final. The score is close, there’s less than two minutes on the clock and if your team makes one more try you’ll be the champions. You see an opening in the defensive line, a chance to make the winning try. Your teammate sees it too and passes you the ball. You make your play. You get tackled close to the line but make it over and get that winning try. But on your dive to the ground your stretch out your hand to brace your body against the fall. You feel something snap in your wrist when you hit the ground but at the first the adrenaline blocks out any pain.
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A few hours later the pain bites as your turn on the tap for the shower. It starts to ache and you can’t sleep. You take some Nurofen, ice it and go to bed. The next morning it’s a little bit swollen and sore but the pain is manageable and it only really hurts when you turn on a tap or grip something. You think “if it was broken it wouldn’t be able to move it at all, must be just a sprain”. After a supposed wrist sprain, many people ignore it and carry on, assuming it will heal. But wrist sprains can be serious. What you do next could be critical to the long-term health of your wrist joint.

Did you know that the wrist joint involves 15 bones with many ligaments joining these bones to each other? Ligaments are pieces of tough tissue that join bone to bone providing stability to joints. This makes the wrist arguably the most complicated joint in the human body. A sprain is an injury to one or more of these ligaments. A fall on an outstretched hand can cause a fracture to any one of these 15 bones, a sprain to some of the ligaments, and/or a dislocation to one of the joints. And the scary part is that a fracture or serious sprain doesn’t always hurt as much as you would expect.
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For this reason, if your wrist hurts after a fall, it’s vitally important to see a doctor to get an x-ray. A neglected injury can lead to an unstable or painful joint for years to come.  Apart from identifying any factures, x-rays can also show any unusual positioning of the bones that may indicate a torn ligament. While it’s encouraging if the x-ray comes back clear, it doesn’t mean you’re out of the woods. Some fractures of the small carpal wrist bones, particularly the scaphoid, are difficult to see on x-ray. Depending on the site of the pain, your GP may recommend another x-ray in a few days or a CT or MRI scan. These other scans can be expensive and not always required in the outset so don’t worry if your doctor doesn’t recommend one.

So, your x-ray shows no fracture, the swelling has gone but your wrist still hurts sometimes. Is it best to wait it out or get treatment straight away? My advice to you is that you should get treatment straight away, as you are likely to recover faster. But it’s important that you see the RIGHT person. Someone who knows wrist injuries and has lots of experience treating them. You can be sure to find someone with the appropriate experience if they are a member of the Australian Hand Therapy Association, soon to be known as an Accredited Hand Therapist. This is an occupational therapist or physiotherapist with additional training and extensive experience managing hand, wrist and elbow injuries. You can find an appropriate therapist here https://www.ahta.com.au/site/find-a-therapist.

Once you’ve booked an appointment with an experienced practitioner in hand therapy, ensure you take any x-rays or scans that you have to your appointment. At your initial appointment, you can expect a thorough wrist and hand assessment. This helps to identify which ligament you have injured and how severe the damage may be, particularly if you haven’t had an MRI. Correct diagnosis allows you and your therapist to develop an appropriate treatment plan. We can help you to understand the role of the injured structures in your wrist and why you should follow our advice for splinting, bracing or taping, activity restriction and therapy exercises.

The two most commonly injured ligaments in the wrist are the triangular fibrocartilage complex (TFCC) and the scapho-lunate ligament (SLL). These ligamentous structures have vastly separate roles and therefore they shouldn’t be treated in the same way.

The TFCC is a group of three ligaments and a cartilage pad. It plays a vital role in stabilising the part of the wrist that performs rotation of the forearm. An injury to the TFCC often causes pain on the little finger side of the wrist, particularly with twisting (such as turning taps) or gripping.

The scapho-lunate ligament has two parts and joins two of the small carpal bones of the wrist: the scaphoid and the lunate. This ligament is very important in making sure the wrist bones move the way that they were designed. An undiagnosed injury to the SLL may lead to serious wrist problems in the future. This injury causes pain in the middle of the wrist with gripping and when leaning on the hand.

After initial assessment to get a diagnosis, several therapy sessions will be required to monitor your recovery and progress your treatment. A custom-made orthosis or semi-rigid wrist splint may be required to rest the injury to allow healing. Gentle and very specific exercises will likely be started early in your rehabilitation and these will change and increase over time. You may also be given some unusual exercises such as using water in bottles or pipes or even rolling marbles on plates!

The most important thing is to get qualified treatment early, follow your treatment guidelines and commit to your recovery plan by dutifully doing prescribed activities and exercises or avoiding restricted activities.  It just might be the difference between a full recovery and partial recovery.  For more articles like this, like our Facebook page https://www.facebook.com/thehandrecoverycentre/ or visit our website for more details https://www.handrecovery.com.au/what-is-hand-therapy/ .

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