Hand Injuries Treated in Physical Therapy

Injuries of the hand and wrist can significantly limit your ability to function at work, perform activities of daily living and participate in recreational activities. Whether it originates from overuse, is a result of a systemic pathology, or a traumatic injury, a hand therapists can assist in restoring function and fine motor control so you can get back to doing the things you love. Below is a description of some of the most common hand and wrist injuries treated by physical therapists with proper hand therapy.


Our Portland physical therapy clinics have the expertise to handle all your hand therapy needs.

Hand Therapy – Tendon Injuries:

Extensor Tendon Injuries: Tendons are connective tissue that connects muscles to bones. The tendons along the dorsum (top) of your fingers, thumb and hands are connected to muscles in the forearm. These muscles are responsible for straightening the fingers and extending your wrist. Damage to these tendons are usually caused by blunt trauma or laceration. There are multiple types of extensor tendon injuries; presentation, symptoms, and impairments will vary according to the location of the injury along the tendon. Below are a few of the most common types of injuries related to extensor tendon damage:

  • Mallet finger – The fingertip is stuck in a bent position and can not be actively straightened, commonly caused by “jamming” the finger.  The force onto the tip of the finger can rupture the tendon where it attaches to the bone. If the rupture is complete, meaning the entire tendon is detached from the bone, the fingertip would only straighten if it is moved passively by the other hand.
    • Physical Therapy treatment: Non-surgical treatment typically involves splinting the fingertip in a straight position to minimize permanent deformity of the finger and allows the tendon to heal. Additional interventions include restoring range of motion and function of the finger.
  • Boutonniere Deformity – The middle joint of the finger becomes stuck in a bent position, while the fingertip is stuck in a hyperextended position. The damage to the extensor tendon looks like a buttonhole and leaves the middle joint bent while the remaining tension pulls the fingertip into a straightened position.
    • Physical therapy treatment: Acute, traumatic injuries are often referred to as a “central slip”. Conservative management of acute injuries will begin with splinting to allow tendon healing in the appropriate position, followed by range of motion and restoration of finger function. Chronic degeneration of joints in the fingers from rheumatoid arthritis (RA), for example, can result in a permanent boutonniere deformity. Prior and during your hand treatment, medical management should be discussed with your physician in the presence of RA or other chronic degenerative pathology.  

Flexor tendon injuries: Flexor tendons attach to finger bones on the palm surface of the hand and attach to muscles in your forearm. These muscles are responsible for bending the wrist, making a fist, and bending the fingers. Because these tendons are long, they are secured by a connective tissue sheath to prevent bowstringing with finger movement

  • Trigger Finger: The flexor tendon can become irritated as it slides through the tendon sheath tunnel. As it becomes more irritated, the tendon may thicken and nodules may form, making its passage through the tunnel more difficult. Trigger finger occurs as the tendon becomes momentarily stuck at the mouth of the tendon sheath tunnel when you try to straighten your finger. Often a forceful attempt to straighten the finger or thumb will produce an audible pop as the tendon slips through the tight area.
    • Physical Therapy Management: Depending on the severity of impairments, a combination of rest, modalities, splinting and joint mobilizations will be utilized to decrease pain, improve ROM and restore proper gliding of the tendon during our hand therapy sessions.

DeQuervain’s Tenosynovitis

De Quervain’s Tenosynovitis:  The term tenosynovitis describes inflammation of the fluid-filled sheath that surrounds tendons. De Quervain’s is specific to the tendons at the base of the thumb. These tendons attach muscles in the forearm to the outside of the thumb through a tunnel of fibrous connective tissue. These injuries typically occur when tendons are overused. For example, this may be after playing a lot of sport or overuse in the course of your work. Pain is felt at the base of thumb and wrist and is increased by moving the thumb away from the hand, grasping, and moving the wrist in the direction of the pinky. Thickening and swelling can also be present.

  • Physical therapy management: The goals of the hand therapy is to decrease pain and inflammation during the early phase of symptoms, followed by specific joint mobilizations, range of motion exercises and strengthening to restore pain-free hand and wrist function.  

Carpal Tunnel Syndrome

Definition: A condition of the hand and wrist characterized by pain, numbness, and tingling. It occurs more frequently in women than men.

Anatomy of the carpal tunnel: The carpal tunnel is a fibrous layer of connective tissue that runs transversely across the front of the wrist. It is a passageway for several tendons and the median nerve as they enter the palm of the hand. The median nerve supplies sensation to the skin over the palm, thumb, index, middle finger and half of the ring finger. It also provides motor activity to muscles supplying the thumb (thenar eminence) and first two lumbricals (responsible for bending the fingers forward).

Carpal tunnel syndrome is characterized by compression of the median nerve within the carpal tunnel. It is the most common mononeuropathy and can be caused by thickened ligaments and tendon sheaths. Its aetiology is not typically associated with any specific event or injury, it is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel. If left untreated, it can eventually cause weakness and atrophy of the thenar (thumb) muscles.

  • Physical Therapy Treatment: Fortunately for most people who develop carpal tunnel syndrome, hand physical therapy treatment can often relieve pain and numbness and restore normal use of the hand, wrist, and arm without the need for surgery.  A hand physical therapists will provide education regarding wrist position and head and neck posture to minimize symptoms. A combination of exercises to increase strength of the hand, wrist and forearm muscles, stretching and night splinting are treatments that have proven to be successful in the management of carpal tunnel syndrome.
  • The largest gains in treatment can be made through lifestyle and postural adjustments. Splinting of the wrist will avoid excessive bending and extending the wrist, thereby giving the wrist a rest. Also, postural adjustments at the patient’s work desk can help with minimizing strain of the wrist and arm.

When carpal tunnel syndrome occurs because of sport it is large due of improper handling of sports equipment. An adjustment in handle can help significantly with reducing strain and pressure on the wrist.

Wrist Injury Treatment

Wrist injuries are most commonly started with frequent or heavy-load twisting and turning of the hands. Not a lot of muscles cross the area of the wrist joint, and because of the orientation of the wrist bones, there is a large degree with movement in this joint with not a lot of stability structures. If too much load is given to such a delicate structure, damage to the tendons that cross this joint can ensue.

wrist injury diagnosis by a therapistMost wrist injuries come by way of a sprain – an unintended twist or bend of the wrist that goes farther than its normal range. Typical mechanisms of injury are: falling on your hand, hitting something at an unusual and unintended angle, manipulating a tool of a racquet past the point of comfort for a long period of time (such as in pulling levers or even in using hair dryer).

Physical therapy for wrist injuries involves soft tissue mobilization and massage to ease tension and pain. Progressive gripping exercises and wrist motions to normalize movement, and to strengthen for future use. Bracing the wrist is also very important in between visits of Physical Therapy so the joint is protected and not continuously aggravated by everyday movements.

If you are experiencing any of the above hand injuries, please contact and visit one of our Portland area clinics located in Beaverton and Hillsboro today!

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Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
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Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
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