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 area physical therapy clinics have the expertise to handle all your hand therapy needs including:
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.
- 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.
Most 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.